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X90 <br />COLORADO Di VISION OF MINERALS AND GEOLOGY <br />••~~ 1313 Sherman Streit, Room 215, Denver, Colorado 80203, (303) 866-3567 <br />+eic' <br />III IIIIIIIIIIIII III <br />999 <br />APPLICATION FORM FOR A REVISION RECEIVED <br />TO A COAL MINING AND RECLAMATION PERMIT <br />JUN 16 1998 <br />This form must be completed and submitted with all requests for minor revisions, a~IVJ€lfifnetlNm~ygl~gl~~Z31. <br />technical revisions, as defined in Rule 1.041136), and permit revisions, as defined in Rule 1.041901. yAll <br />revisions are to address the requirements of Rule 2.08.4. Three 13) 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 OSMI 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 - (~ I - Q ~ ~ ~~I7~~__ Date: c-cJ~ / _ 2Q / <br />• Permittee: ~Sj,rn1Llr;Nl~ /ulf~6fJ6 L.LKI'O12.4TLOt~I <br />Street: iU~>rt.A~rz +3 iCA~VAwN,4 t3f.t1.D (~ ~5'J1zF~ <br />Po (fix ~4~4 <br />city: C?N-Alttesroti <br />State: lt9V Zip Code: a~J~~-7 - <br />Brief Description of Revision: _~MJbE {(~ lati+f^CafrTf4-ROt~ ~trct~s5 <br />/iPI'f ~2G4 <br />Public Notice Attached: Yes ZC No _ (Required for PRs and TRsI <br />i <br />Bond Increase: Yes _ No ~C Federal _ Non-Federal _ Mine <br />Proposed Change in: <br />Disturbed Area (+ /-1 _ _ ~ . _ Acres Affected Area (+!-) _ _ C~ . _ Acres <br />Permit Area (+/-) _ _ p . _ Acres Federal Land 1+/-) _ _ ,O . _ Acres <br />State Land (+/-) O Acres Private Land 1+1-) ~ Acres <br />