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STATE OF <br />'~~~rI510N OF MINERALS AND GEOLOGY <br />4epanmenl of Natural Resources ~~~ q q 'nn7 ~_ <br />U 1 J Sherman SL, Room 215 G V IW7I <br />Denver, Colorado 80203 <br />Phone: 1703) 866-3567 rviSron Of Minerals & Geol <br />FAX: 1703) 932-8106 APPLICATION FORM FOR A REVISI011~ DEPARTMENT OF <br />TO A COAL MINING AND RECLAMATION PERMIT NATURAL <br />RESOURCES <br />This form must be completed and submitted with all requests for minor revisions, as defined in Roy Romer <br />Rule 1.04(73), technical revisions, as defined in Rule 1.04(1361, and permit revisions, as defined cOVef"Of <br />in Rule 1.04(90). All revisions are to address the requirements of Rule 2.08.4. Three 13) copies a%tt rs~ D nnttead <br />of the revision, including maps, must be submitted in order for it to be complete. MKnaei e. \o~s <br />Division Direcrur <br />All revisions are to be formatted so they can be inserted into the permit to replace the revised <br />sections, maps, tables and/or figures, with a revised table of contents, if necessary. The revision submittal <br />date should be printed in the lower right corner of each revision page. A cover letter to the revision should <br />explain the nature of the revision and reference the specific permit sections being revised. <br />For federal mines, a copy of the revision application must be submitted to all agencies on the federal mailing <br />list at the same time the application is submitted to the Division, and proof of distribution must be submitted <br />to the Division along with the application. Copies of revision pages modified during the review process must <br />be distributed in the same manner, along with proof of distribution. Proof of distribution must be submitted <br />prior to implementation of the revision. For non-federal mines, a copy of the application for which the <br />Division has issued a proposed approval decision must be submitted to the OSM Western Regional <br />^oordinating Center (7999 Broadway Blvd., Suite 3320, Denver, CO 80202-5733), and proof of submittal <br />~ OSM must be submitted to the Division prior to implementation of the revision. <br />Permit No.: C- 8 ?- ~ 5 ? Date: 0 6/ 2 0/ 9 7 <br />Permittee: 5 <br />- E <br />- N <br />- E C <br />- - A C 0 A L <br />- - - - - - - - - - <br />C 0 M P A N Y ___ _ J_ _ <br />Street: 1 <br />- 3 <br />- 0 <br />- 0 <br />- - S 0 U T H Y A L E <br />- - - - - - - - - - <br />Clty: F L A G S T A F F <br />State: A Z Zip Code: 8 6 0 0 1-____ <br />Brief Description of Revision: H A U L ROAD A / P O N D_ 0 0 6 <br />LAN D S L I D E R E M E D I A T I O N <br />- - - - - - - - - - - - - - <br />P L A N <br />- - - - - - - - - - - - - - <br />Public Notice Attached: Yes R No _ (Required (or PRs and TRsJ <br />Bondlncrease: Yes No R Federal x Non-Federal Mine <br />Proposed Change in: <br />isturbed Area (+/-) _ _ 0 0 Acres Affected Area (+/-) _ _ 0 ~ Acres <br />Permit Area (+/-) _ _ 0 ~ Acres Federal Land (+/-) _ _ ~ ~ Acres <br />State Land (+/-) _ _ 0 0 Acres Private Land (+/-) ` _ ~ 0 Acres <br />m: \coal\sharelforms18865 <br />