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;,r-~ STATE O DIVISION OF MINERALS AND GEOLOGY Ally "~ guru `^,t Depanmem of Natural Recourcec +,n96 171 d $hcrntan $I .Room ? I S / 7 II~~~ rn~ne~um~a h~JSlzo\ AppLiCATION FORM FORVIA REV~SION & Geology rnx. uml a3>~drot~ TO A COAL MINING AND RECLAMATION PERMIT DEPARTMENT OF NATURAL RESOURCES This form must be completed and submitted with all requests for minor revisions, as defined in Rny Rnmc, Rule 1.041731, technical revisions, as defined in Rule 1.041136), and permit revisions, as defined cOVPf"Uf in Rule 1.041901. All revisions are to address the requirements of Rule 2.08.4. Three 131 copies E+ecvi ve Dhcr,o of the revision, including maps, must be submitted in order for it to be complete. n,lcnael o E„„~ Diva>mn Dneuur 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 submittal 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 be submitted to all 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 sarne manner, along with proof of distribution. Proof of distribution 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 ~Nestern Regional Coordinating Center (1999 Broadway Blvd., Suite 3320, Denver, CO 80202-5733), and proof of submittal to OSM must be submitted to the Division prior to implementation of the revision. Permit No.: C-~ 1- ~ 3 a Date: - g/ 1 6 / 9 6 Permittee: E N ~, o N - e- O A~ ~. - C O - __ Street: ~ ~ - d ~ ~ - 1 ~ ~ -~ City: ~ ~ ~ ~ S Q ~ - - - - - - - - State: ~~ Zip Code: ~ ? a ~ L -1 ~ ~ £~ p Brief Description of Revision: l} ~ ~/~LIIIJ~ ~p / ~2~pE_/Q~y- ~NdVISE 1/E~-lq~ ~Q~/~,Q - Public Notice Attached: Yes Bond Increase: Yes No Proposed Change in: No - (Required for PRs and TRsI Federal Non-Federal Mine Disturbed Area (+/-1 ~ _ Acres Permit Area (+/-) ~ . Acres State Land (+/-) - - D . -Acres Affected Area (+ /-) O , Acres Federal Land (+/-) - - Q . -Acres Private Land (+/-) ~ Acres m:1co al\share\f orm s\886 5