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STATE OF COLORADO DIVISION OF MINERALS AND GEOLOGY FtVED D ment ai Natural Resources ry ~herman 5L. Roam 215 APR 1 ! 199A Drover. Colorado 80z0] %vme: 11031866.3567 FAx:1lo31 a3z-afar, APPLICATION FORM FOR A REVISI~IYlsion of Minerals & ua~. TO A COAL MINING AND RECLAMATION PERMIT This form must be completed and submitted with all requests for minor revisions, as defined in Ror Rorer Rule 7.04(73), technical revisions, as defined in Rule 1.04(136), and permit revisions, as defined ~OY`A10f in Rule 1.04(90). All revisions are to address the requirements of Rule 2.08.4. Three 13) copies la"r's.l«hnead Eaecutire OireUw of the revision, including maps, must be submitted in order for it to be complete. michael B. Lmc Oiritim Oirenw All revisions are to be formatted so they can be inserted into the permit to replace the revised sections, maps, tables and/or figures, with a revised tahle of conrents, if necessary. The revision submittal date should be printed in the lower right corner of each revision page. A cover letter to the revision should explain the nature of the revision and reference the specific permit sections being revised. For federal mines, a copy of the revision application must be submitted to all agencies an the federal mailing list at the same time the application is submitted to the Division, and proof of distribution must be submitted to the Division along with the application. Copies of revision pages modified during the review process must be distributed in the same manner, along with proof of distribution. Proof of distribution must be submitted prior to implementation of the revision. For non-federal mines, a copy of the application for which the Division has issued a proposed approval decision must be submitted to the OSM Western Regional oordinating Center (1999 Broadway Blvd., Suite 3320, Denver, CO 80202-5733), and proof of submittal SM must be submitted to the Division prior to implementation of the revision. Permit No.: C - S 2 - 0 5 6 Date; __p_ ~ / ~ ~ / g_ ~ Pertnittee: T W ~ ~_ ~ ~ M I ~ ~ C O ~ ~- C O M B A ~I_ Y--- Street: 2 9 5 1 y5, R O U T T- C O U N ~ Y R O ~ ~ - ~• ? ~------- City: O A ~(_ - C I~ E ~, K - - - - - - State: C O Zip Code: 8 0 4 6 ~ - - - - - Brief Description of Revision: Mine remaind er of resource located in EMD (Panels _2 Ri ght~hrough_ 6 Rioht) Public Notice Attached: Yes X No- (Required for PRs and TRs) Bond Increase: Yes _ No X Federal Non-Federal - Mine P osed Change in: ~urbed Area (+1-) - - ~ . ~ Acres Affected Area (+l-) 1, L4 ~ . L Acres Permit Area (+/-) - - 0 0 Acres Federal Land (+/_) - - ~ . (L Acres State Land (+l-) - - 0 0 Acres Private Land (+l-) - - _Q__ . 0 Acres -. ~....,n. ~. ~.etin.mclRRgS