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STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Depanmenl of Natural Resources <br />1713 Sherman St., Room 215 <br />Denier, Colorado 80207 <br />Phone: (303) 866.3567 APPLICATION FORM FOR A REVISION <br />FA%: (3031832.8106 <br />TO A COAL MINING AND RECLAMATION PERMIT <br />This form must be completed and submitted with all requests for minor revisions, as defined in i:erRamr.. <br />Rule 1.04(731, technical revisions, as defined in Rule 1.0411381, and permit revisions, as defined ~^~ <br />in Rule 1.04(901. All revisions are to address the requirements of Rule 2.08.4. Three 131 copies lames s. 1«hhead <br />of the revision, including maps, must be submitted in order for it to be complete. raeaniK Di,eaor <br />Michael B. lanB <br />Division Di,enw <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 <br />submittal date should be printed in the lower right corner of each revision page. A cover letter to the <br />revision should 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 Droposed approval decision must be submitted to the OSM Albuquerque Field Office <br />(AFO), and proof of submittal to AFO must be submitted to the Division prior to implementation of the' <br />revision. <br /> <br />0 <br />4 <br />4 <br />0 1 <br />1 <br />9 -n <br />5 <br />'C/ <br />Perrnk NO.: C- 8 1- / <br />7/ <br />Date: V <br /> ~D <br />Jq <br />~ <br />Permlttee: C Y P R U S _ E M P I R E'_ _~~~. <br />~~ <br /> 9 <br />~'0' / 9 <br /> <br />C <br />0 R <br />P <br />0 <br />R A T I 0 N ___ S <br />_ ~., <br />Street: P 0 B O X 6 8 ~ ~~' <br />UNV/ <br /> 0 <br />9y <br />City: C $ ~ I G _ _ _ <br />State: C O Zip Code: 8 1 6 2 6_ <br />Brief Description of Revision: T R_ 9 5= 3 6 <br /> <br />Public Notice Attached: Yes X No _ (Required for PRs and TRsI <br />Bond Increase: Yes No % <br />Proposed Change in: <br />Disturbed Area l+/-) _ ~ g <br />Permit Area. (+/-) _ N A <br />Federal x Non-Federal Mine <br />_ Acres Affected Area (+/-) _ ~ g . _ Acres <br />_ Acres Federal Land (+/-) _ N A . _ Acres <br />?~ <br />State Land (+/-) _ N A . _ Acres Private Land 1+/-) _ N a _ Acres <br />m:\codbhars\lorma\e9e 6 <br />