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<br />STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY ~I <br />Depanmenl of Natural Resources <br />1717 Sherman St., Room 215 RECEIVED ~~~~ <br />Denver, Colorado 8020) <br />FAxn170 ~eIlZ6B 06 2 APPLICATION FORM FOR A REVISION ~U~ ~ 2 <br />TO A COAL MINING AND RECLAMATION PERMIT 995 DEPARTMENT (t~ <br />Division of Mmera! RE OURC ~` <br />This form must be completed and submitted with all requests for minor revisions, as def ned nolog RoyR~ <br />Rule 1.04(731, technical revisions, as defined in Rule 1.04(361, and permit revisions, as defined covcrrur <br />in Rule 1.041901. All revisions are to address the requirements of Rule 2.08.4. Three 131 copies I+rr~ s. Lochhead <br />of the revision, including maps, must be submitted in order for it to be complete. Ei1u1yD11'°r <br />Michael 8. Long <br />Division Dirttb, <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 proposed approval decision must be submitted to the OSM Albuquerque Field Office <br />(AFOI, and proof of submittal to AFO must be submitted to the Division prior to implementation of the <br />revision. <br />Permit No.: C- 8 3 - 0 5 9 Datc: 0 6 /0 8/ 9 5 <br />Perntittee: T E R <br />- - - R <br />- O R C <br />- - - - R E E K C O M P A N Y <br />- - - - - - - - - - - - - - - - - - - <br />Slreet: 1 8 4 <br />- - - 0 <br />- H I G <br />- - - - H W A Y 1 3 3 <br />- - - - - - - - - - - - - - - - - - - <br />- - - - - - - - - - - - - - - - - - - - - - - - - - - <br />City: P A O N I A _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ <br />State: C O Zip Code: 8 1 4 2 8- <br />- - - - - - - - - - - - - - <br />Brief Description of Revision: C O N S T R U C T_ A_ C O N C R E T E_ <br />C O N T A I N M E N T_ F O R_ G A S__ <br />A N D_ D I E S E L_ S T O R A G E___ <br />Public Notice Altacl-ed: Yes XX No _ (Required for PR's and TR's) <br />Bottd Increase: Yes XX No _ Federal _ Nolt-Federal XX Mine <br />Proposed Change ill: <br />Disturbed Area (+/-) _ _ 0.0 Acres Affected Area (+/-) _ _ 0.0 Acres <br />Permit Area (+/-) _ _ 0.0 Acres Federal Laud (+/-) _ _ 0.0 Acres <br />State Land (+/-) _ _ 0.0 Acres Private Laltd (+/-) _ _ 0.0 Acres <br />