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STATE OF COLc III IIIIIIIIIIIIIIII DIVISION OF MINERALS AND GEOLOGY Department of Natural Rtsources RECEIVED 13l 3 SFterman St.. Room 215 Denver, Colorado 80203 Phone: f303t a66.3567 ~ MAV Q ~ ~97 FA%: tJ071 8]2.8106 APPLICATION FORM FOR A REVISION ~ V11 TO A COAL MINING AND RECLAMATION PERMIT gwltlWn ai Minerals Q ®oale~r This form must be completed and submitted with all requests for minor revisions, as defined in Rov ltomrr Rule 1.041731, technical revisions, as defined in Rule 1.0411361, and permit revisions, as defined ~O"'"Of in Rule 1.04(901. All revisions are to address the requirements of Rula 2.08.4. Three 131 copies lames s. Lachhe,d Fsecunve Direap of the revision, including maps, must be submitted in order for it to be complete. .~tichad B. Loot; Divifion Direet~r 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 table of contents, if necessary. The revision submitta! 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 he submitted to ell agencies on 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 disuibution, Proof of disuibution 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 Coordinating Center (1999 Broadway 81vd., Suite 3320, Denver, CO 80202-57331, and proof of submittal to OSM must be submitted to the Division prior to implementation of the revision. Permit No.: C - 8 4 0 ~_ 2 Date: ~ ~ I ~ ~ I ~, Z Permittee: C Q_ L O R A D O _ Y A M ~ A C Q A ~_ C 2 M P A N Y___ Street: R O U T T C O U N T Y__ R ~_ A D__ # 2 7 _ ______ City: O A K_ C R E E K ______ State: C Q Zip Code: S 0 4 6 7- _~__ Brief Description of Revision: RETENTION OF MIDDLE CREEK'"OFFICE AND PARKING AREA AND CLARIFICATION OF SHRUB STANDARD A PART OF VEGETATION S 1 .ECG C'RIT RIA Public Notice Attached: Yes X No_ (Required for PRs and TRs) Bond Increase: Yes _ No X Federal_ Non-Federal X Mine Proposed Change in: Disturbed Area (+/-) N A _ _ Acres Permit Area (+1-) N A _ , _ Acres State Land (+l-) N A _ _ Acres Affected Area (+/_) ~ ~ _ , _ Acres Federal Land (+/_) N A _ , _ Acres Private Land (+/_) N A _ _ Acres m:1c oa I\s ha re\form 516 B65