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<br />STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Depanmem o! Natural Resources <br />I l13 Sherman Si.. Room 215 ~I~ <br />Denver, Colorado 60101 <br />Phone: 13031 666JSb7 <br />FAX: 00 71 87 2-8106 APPLICATION FORM FOR A REVISION DEPARTfvtENT OF <br />TO A COAL MINING AND RECLAMATION PERMIT NATURAL <br />RESOURCES <br />This form must be completed and submitted with all requests for minor revisions, as defined in Roy Rome, <br />Rule 1.04173), technical revisions, as defined in Rule 1.04(136), and permit revisions, as defined cOVe'"°` <br />in Rule 1.04(901. All revisions are to address the requirements of Rule 2.08.4. Three (3) copies Ea ~~ Sve o h~eao <br />of the revision, including maps, must be submitted in order for it to be complete. <br />Michael B. Long <br />D."uinn Dlredu~ <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 submittal <br />date should be printed in the lower right corner of each revision page. A cover letter to the revision should <br />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 ai 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 Western Regional <br />Coordinating Center (1999 Broadway Blvd., Suite 3320, Denver, CO 80202-5733), and proof of submittal <br />to OSM must be submitted to the Division prior to implementation of the revision. <br />Permit No.: C - ~ I - O ~' ~ Date: ~ J / a `~ / 9 <br /> <br />Street: ~ y~ ~ ~ - <br />~_ u (~ fi ~ <br />city: ~ E Al V C <br />State: C- ~ Zip Code: <br />Brief Description of Revision: <br />1 ~ ± r! ~~~e e ~ <br />-~ SQ------- <br />~Q E S T -~ A ~C ---- <br />~NS T A L L Y T~ O N -_ <br />Public Notice Attached: Yes' /- No Required for PRs and TRsI <br />Bond Increase: Yes - No /~ Federal - Non-Federal ~ Mine <br />Proposed Change in: <br />Disturbed Area (+ /-) - - Q <br />Permit Area (+/-) - - /~~~ <br />State Land (+/-) - - n <br />~ Acres Affected Area (+/-) - - <br />~_ <br />. ~ Acres <br />~ Acres Federal Land (+/-) - n <br />\ <br />- n ~ Acres <br /> Acres Private Land (+/-) - - ~. ~ Acres <br />m ~\coallshare\forms\8865 <br />