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<br />STATE OF COLORADO <br />MINED LAND RECLAMATION DIVISION <br />pe ~ co~ <br />Department of Natural Resources <br />1313 Sherman St.. Room 215 ~ <br />~~ <br />RECEIVED ~~%~ig <br />Denver, CO 60203 <br />~ ~ ` ° ` <br />~ <br />+ <br />303666-3567 ~1 <br />'ye~e' <br />MAY 03 1995 <br />Fax: 303 632-8106 <br />Ray Romer, <br />Gwertgr <br />Division of Minerals & Geology, Frey R. Banta. <br />APPLICATION FORM FOR A REYISION Division Director <br />TO A COAL MINING AND RECLAMATION PERMIT <br />This form must tie completed and submitted with all requests for minor <br />revisions, as defined in Rule 1.04(73), technical revisions as defined in <br />Rule 1.04(36) and permit revisions, as defined in Rule 1.04(90). All <br />revisions are to address the requirements of Rule 2.08.4. Three (3) copies of <br />your revision including maps must be submitted in order for it to be complete. <br />All revisions are to be formatted so they can be inserted into the permit to <br />replace the revised sections, maps, tables and/or figures. Explain in the <br />revision what section is being revised. The revision date should be printed <br />in the lower right corner of the revision pages. If necessary, the Table of <br />Contents should also be revised. When the final version of the revision is <br />• approved, 7 copies nest be sent to OSM in Denver far Federal mines and for . <br />non-Federal mines 1 copy must be sent to OSM at 625 Silver Avenue, SW, Suite <br />310, Albuquerque, New Mexico 87102. The revision may not proceed until OSM <br />has been provided copies. Copies should be sent certified mail. <br />Permit No.: C - ~ g - (~ G 3 <br />Date: O ~/ L f / F ~ <br />Permittee: ~~ ~,~ ~~.,~ ~'~,~,~ TL`•C_ - <br />- - - - - - - - - - - - - - - <br />Street: ~ ~ ~3a, /(,/ - - - <br />City: ~~~ -.---------------- <br />State: G O Zip Code: ~ L (ice Z - - - - - <br />Mine Name: ~~~~17r~~-______ _____ <br />Brief Descri pti on of Revision: ~?~„~-,~ ~~(~- - - - - - <br />Public Notice Attached - Yes _- No ~ (Required for PR's and TR's) <br />Bond Increase: Yes No 0~ Federal Non-Federal ~ Mine <br />• <br />Proposed Change in: <br />Disturbed Area (+/_) _ - Q,~2 Acres Affected Area (+/-) - - ~, a Acres <br />Permit Area (+/-) - - ~,Q Acres Federal Land (+/-) _ - ~ Acres <br />State Land (+/-) - - ~ Acres Private Land (+/-) - - ~ Acres <br />ciao /in innl <br />