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pf COQ pp <br />COLORADO DIVISION OF MINERALS AND GEOLOGY <br />y' ~ 1313 Sherman Stre ,Room 215, Denver, Colorado 80203, (303) 866-3567 <br />/896 ~ <br />~-y~~~~vED <br />APPLICATION FORM FOR A REVISION <br />TO A COAL MINING AND RECLAMATION PERMIT AU6 2 2 ZOOS <br />pivisinn ei Minerals and Geology <br />This form must be completed and submitted with all requests for minor revisions, as defined in Rule 1.04(73), <br />technical revisions, as defined in Rule 1.04(136{, and permit revisions, as defined in Rule 1.04(901. All <br />revisions are to address the requirements of Rule 2.08.4. Three (3) copies of the revision, including maps, <br />must be submitted in order for it to be complete. <br />All revisions are to be formatted so they can be inserted into the permit to replace the revised sections, maps, <br />tables and/or figures, with a revised table of contents, if necessary. The revision submittal date should be <br />printed in the lower right corner of each revision page. A cover letter to the revision should explain the nature <br />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 (except OSM) at the same time the application is submitted to the Division, and proof of distribution must <br />be submitted to the Division along with the application. Copies of revision pages modified during the review <br />process must be distributed in the same manner, along with proof of distribution. Proof of distribution must <br />be submitted prior to implementation of the revision. <br />Permit No.: C - ~O - 006 Date: 8 / 8 / ~3 <br />Permittee: K(=RR CoA i.. G©MPH~ <br />Street: ~0 QOx tFSR <br />City: f= (-.~I~k.f~C1= <br />State: CO Zip Code: S l 22ro - <br />Brief Description of Revision: (2ECL{~MATic1n/ GRazltilG f L~lf~1 <br />~J2 41=.~1R 2~r~3 <br />Public Notice Attached: Yes <br />Bond Increase: Yes No X <br />No X (Required for PRs and TRsI <br />Federal <br />Non-Federal X Mine <br />Proposed Change in: <br />Disturbed Area (+/-) o o Acres <br />Permit Area i+/-) o o Acres <br />State Land I+/-) o o Acres <br />Affected Area (+/-) o . o Acres <br />Federal Land f+/-) ~ . o Acres <br />Private Land (+/-) o o Acres <br />