REV10008

• Permit No: C1981023
• IBM Index Class Name: Revision
• Doc Date: 5/2/1994
• Doc Name: APPLICAITON FORM FOR A REVISION TO A COAL MINING AND RECLAMATION PERMIT
• Type & Sequence: TR25
• Media Type: D
• Archive: No

• • iiiiiiiiiiiiiiuiii
STATE OF COLvi 9v;uv
Roy Romer, Governor
~.
DEPARTMENT OF NATURAL RE90URCE3
MINED LAND RECLAMATION DIVISION
FNED R. BANTA, Clneter APPLICATION FORM FOR A REVISION
TO A COAL MINING AND RECLAMATION PERMIT
This form must be completed and submitted with a1T requests for minor revisions, as defined
in Rule 1.04(73), technical revisions as defined in Rule 1.04(36) and permit revisions, as
defined in Rule 1.04(90). All revisions are to address the requirements of Rule 2.08,4,
Three copies oP your revision including maps must be submitted in order for it to be complete,
All revisions are to be formatted so they can be inserted into the permit to replace the
revised sections, maps, tnbles and/or figures. Explain 1n the revision what section 1s being
revised. The revision date should be printed in the lower right corner of the revision
pages. If necessary, the Table of Contents should a15o be revised. When the final verston
of the revision is approved, 7 copies must be sent to OSM in Denver for Federal mines and Por
non-Federal mines 1 copy must be sent to OSM at 625 Silver Avenue, SW, Suite 310,
Albuquerque, New Mexico 87102. The revision may not proceed urltll OSM has been provided
copies. Copies should be sent certified mail.
Date: D S/~2/gam
Permittee: ~ .g l cj ~ ~ - ~ ~ 5 o yL r G ~S
Street: P ~1~~_3~ ~ ~- 3 ? ----
- - - - - - - - - - - - - - -
State: L $ Zip Code: g Z ~ 3 R - - _• - -
Permit No.: C-~ L - o Z 3
4ine Name: C~y~~y~ c~-gam c 1G-~F,L r1g_-_
Type of Revision: '7~,'iZ (PR, TR, or MR)
Revision Number: ~ ~ (Sequential by Revision Type)
Rev. Submittal Date: _ _/_ _/_ _ (Date Received by Dl vision)
Rev, Completeness Date: _ -/ -/- - Rev. Incompleteness Date: - -/- _/- -
Rev. Adequacy Due Date: - -/- -/- - Rev. Adequacy Date: - -/- -/- -
Rev. Decision Due Date: _ _/ _/- - Lead Reclamation Specialist: _ - -
rte escr p ion o ev s on: s~s~.~g-~f-~ ~~~
Public Notice Attached -Yes ~ ~o }~(Regl~r~ ~r~R s and~TR s)
Bond Increase: Yes No ~- a eral ~ Non-Federal Mine
Proposed Change in:
Disturbed Area (+/-) d , Acres Affected Area (+/_) ~.- pcres
Permit Area (+/-) - _ Q._ Acres Federel Land (+/-) - -' g Acres
State Land (+/-) -_ - Q Acres Private Land (+/-) _ _ 2 Acres
6185E (Rev. 10/88)
216 Centennial Building, 1313 Snerman Street Denver, Coloredo 80203.2273 Tel. [phone]
Z£~£i 46. Z0 .ltiW £0d £££ 3NO1S1.3J9 86Z6SZL£0£