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~ 7' .oF corn <br />. yeti , /,~ ~.p9o <br />+ 1876 s <br />Hichartl D. Lamm <br />Governor <br />• 23 ~ ~ <br />DEPARTMENT OF NATURAL RESOURCES <br />Dantl H- Getches. E.ecutne Director <br />MINED LAND RECLAMATION DI1 <br />DAVID C. SHELTON, Director <br />APPLICATION FORM FORA REVISION <br />TO A COAL MINING AND RECLAMATION PERMIT <br />This dorm must be completed and submitted with all requests for minor revisions, as. <br />defined in Rule 1.04(73), technical revisions as defined in Pule 1.04(36) and permit <br />revisions, as defined in Rule 1.04(90). All revisions are to address the requirements -' <br />of Rule 2.08.4. <br />All revisions are to be formatted so they can be inserted into the permit to replace the <br />_ revised sections, maps, tables and/or figures. Explain in the revision what section is <br />,, being revised. The revision date should be printed in the lower right corner of the <br />revision pages. If necessary, the Table of Contents should also be revised. <br />i <br />Date: 4. ~/ ~ 7 / 8 7 <br />-' Permittee: ~ .~ 14 R A D Q_ Y A M P A_ `~ <br />~~~1-~..QlLP.. A N Y ~~~~~ ®~r <br />Street: 2 9 5 8 8_ R 0 U T T___~ ~+® <br />0 0 0 N T Y_ R O A D 2 7 1987 _ <br />City: ~~~_ C R E E K_----~_--FEB 20 <br />State: ~ ~ Zip Code: ~ ~ ~ 6 7 - _ _ _ _ MINED ~~~ <br />Permit No.: C- 8 1- 0 7 1 RECLAMATION DIVISION <br />This box to be filled in by the Division: <br />Type of Revision: ~ (PR, TR, or MR) - <br />Revision Number ~ ~ (Sequential by Revision Type) <br />Revision Submittal Date ~ /~/ ~~Date Received by Division) <br />3 <br />P.evision Completeness Date a_1~/k~7 Revision Incompleteness Date _I I <br />Revision Adequacy Due Date ~ Revision Adequacy Date ~ h3/~ <br />Revision Decision Due Date 3 /s /~ 7 Fee E0.00 ' <br />Brief Description of Revision: ~~ Q C H E M I C A L____ <br />S A M P L I N G <br />- - - - - - - - - - - - - - - - - <br />Public Notice Attached - Yes No X (Required for PR's and TRrS) <br />Bond Increase: Yes _ No _~ <br />Proposed Change in: <br />Disturbed Area (+/-) _ ~/A._ Acres Affected Area (+/-) _ N/A ._ Acres <br />Permit Area (+/_) _ ~jg,_ Acres Federal Land (+/_) _ ~A Acres <br />State Land (+/_) - ~/g Acres Private Land (+/_) _ ~A Acres <br />Lead Reclamation Specialist ~ / ~ 6185E <br />423 Centennial Building, 1313 Sherman Street Denver, Colorado 80203 Tel. (303) 866-3567 <br />