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-,.:.. <br />STATE OF COLORADO <br />MINED LAND RECLAMATION DIVISION aF ~o~ <br />Department of Natural Resources ~``~Qs <br />t 313 Sherman St.. Room 215 ~!'' ~ ~$ <br />Denver. CO 80203 •~;\L~• <br />303 866-3567 're ~a ,• <br />Fax: 303 832-Bt06 <br />Roy Romer. <br />Governor <br />Fretl R. Banta. <br />APPLICATION FORM FOR A REVISION ,~~ Dnision oire:tor <br />TO A COAL MINING AND RECLAMATION PERMIT <br />44 a <br />This form must be completed and submitted with all requests~for9minor <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-1~1~ff4t~~-~cki'1 <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 must be sent to OSM in Denver for Federal mines and for <br />non-Federal mines 1 copy mist 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- 8 1- 0 1 9 <br />Date: +_ 1/ 2 7/ 9 4 <br />Permittee: G 0 L 0 W Y 0_ C 0 A L_ C ~ <br />State: c o Zip Code: 8 1 6 x 1- _. -- <br />Mine Name: c o L o w Y o i i <br />.--.------------------ <br />Brief Description Of ReviSiOn: REQUEST FOR OPERATOR NAME CHANGE AND _ _ _ _ <br />NOTICE OF INTERNAL REORGANIZATION _ i <br />Street: 5 7 3 1 S T A T E i i <br />H I G H W A Y_ 1 3` i_ i <br />Clty: M E E K E R i _ _ , _ _ _ _ _ _ i _ _ i <br />Public Notice Attached - Yes No x (Required for PR's and TR's) <br />Bond Increase: Yes No x Federal x Non-Federal Mine <br />Proposed Change in: <br />Disturbed Area (+/-) _ _ _ Acres <br />Permit Area (+/-) i Acres <br />State Land (+/-) _ _ _ Acres <br />Affected Area (+/-) _ _ _ Acres <br />Federal Land (+/-) _ _ _ i Acres <br />Private Land (+/_) Acres <br />F1ARF n niGni <br />