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r <br />STATE OF COLOlZADO <br />• DIVISION OF MINERALS AND GEOLOGY <br />Depanment o(Natural Resources <br />1313 Sherman St., Room 215 R ~~ F I VE D ~V14 <br />Denver, Colorario tl0203 ~~~ I ~ 1~9 II <br />Phone: (303) 866~35fi7 a <br />FAx: 17071 832-811)6 APPLICATION FORM FOR A REVISION <br />TO A COAL MINING AND RECLAMATION PE~~~b DEPARTMENT OF <br />v i n of Minerals & Ge TURAL <br />SOURCES <br />This form must be completed and submitted with all requests for minor revisions, as defined in Rny Romer <br />Rule 1.04173), technical revisions, as defined in Rule 1.0411361, and permit revisions, as defined c°"e`no` <br />in Rule 1.04(90). All revisions are to address the requirements of Rule 2.08.4. Three 131 copies EaeCU`s.eDhneo <br />of the revision, including maps, must be submitted in order for it to be complete. <br />nt~chael P. long <br />Drvumn pirecun <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 />Coordinating Center (1999 Broadway Blvd., Suite 3320, Denver, CO 80202-5733), and proof of submittal <br />• to OSM must be submitted to the Division prior to implementation of the revision. <br />Permit Na.: C - 8 2 - 0 ~ L Date: Q ~ / L L / ~ ~ <br />Permittee: S E N <br />- - - E C <br />- - A <br />- C <br />- - 0 A L <br />- - - - - - - <br />C 0 M <br />- - - P A <br />- - N <br />- Y <br />- - <br />- - - - - - - <br />Street: 1 3 0 <br />- - - 0 <br />- - S <br />- 0 U <br />- - T H Y A L E <br />- - - - - - - <br />City: F L A G 5 T A F F_ <br />State: A? Zip Code: 8 6 0 0 1_ <br />Brief Description of Revision: W 0 0 D Y _ P L A N T_ D E N S I T Y <br /> S T A N D A R D P E R S T I P U L A T I QN_ <br /> 2 3 <br />- <br />- - <br />- - - - - - - - - - - <br />Public Notice Attached: Yes x N o _ /Required for PRs and TRsJ <br />Bond Increase: Yes No X Federal X Non-Federal Mine <br />Proposed Change in: <br />• Disturbed Area (+/-) _ _ ~ ~ Acres Affected Area (+/-) _ _ ~ ~ Acres <br />Permit Atea (+/-) _ _ 0 0 Acres Federal Land (+/-) _ _ ~ . ~ Acres <br />State Land (+/-) _ _ 0 0 Acres Private Land (+/-) _ _ 0 0 Acres <br />m:\coal\share\f orms18865 <br />