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111 Il!l1111!!lIIIII <br />STATE OF COLORADO <br />.-~ <br />( <br />Roy Romer, Governor <br /> <br />DEPART6IENT OF NATURAL RESOURCES ~ <br />MINED LAND RECLAMATION DIVISION '~~~,~.~~ <br />111ED n. EAtRA, Otreeter APPLICATION FORM FOR A REVISION ~ 'J= ~ ~ ~ ,f ~• <br />TO J1 CQAL MINING ANO RECLAMATION PERMIT . <br />This form gust De caopleted and wDatltted with all reouests for ainor redsiohs, as defined <br />in Rule 1.04(73), techniuT recisions as defined in Rule 1,04(36) and pertait revisions. as <br />defined in Ruie 1.04(90). A11 recisions are to address the requirements of Ruie 2.08.4. <br />Three copies of your recision including maps oust D! submitted in order for it to De complete. <br />A11 revisions are to De to-matted so they can be inserted into the permit to replace the <br />revised sections. maps. tables and/or figures..E.tplain in the revision rhai section is bein? <br />revised. The revision date should be printed in the loner right corner of the revision <br />gages, If necessary, the Table of Contents should also be revised. :then the final versidn <br />of the revision is approved, 7 copies must tk sent~to OSM in Denver for Federal mines an! `:~ <br />non-Federal mines 1 copy must be Bern: to OSM at 625 Silver Avenue, 91, Suite 310, <br />Albuquerque, New Ftexico 87102. fie recision taay not proceed urn:tl OS)tAas,Oeen,prori;ed <br />cosies. Copies shouid be sent certified qil, <br />]ate: _ ~/ / ~,/ ~ ~ JUN 31994 <br />ae-mtttee: ~~S i N _ ~~Soc~,2~s _ <br />-- <br /> <br />city. ~~,S~a~ --------- <br />Sta te: ~ (~ Zip lade: ~ (d ~ ~ + <br />?ermiL 110.: C - 81 - O I 3 <br />;line 11ame: G~ [, ~~ iU_~/t'G G ~_ _ _ <br />tis ox o e r e in y e rrrs on• <br />Type of Revision: ~LZ (PR, TR, or Mt)• <br />Revision 11ur~ber: _ _ (sequential Dy Recision Type) <br />Rev. Submittal Date: _ _/ _/ _ (Date Received Dy Division) <br />Rev. Completeness Date: ` _/ _/_ _ Rer. Incanpleteness Date: / `/_ _ <br />Rev. Adequacy Due Oate: / / Rer, Adequacy Date: / / <br />Rev. decision Due Date: / J Lead Reclamation Specialist: <br />-- <br />ynet Descnptton of eevrsron: /t ~~L~W= of k_~_P~_I'1r4?s <br />Public Notice Attached -Yes -"1(ti ~qu`rre~ ~r'~R s andZR s)"" <br />Bond Increase: Yes ~ 110- ~eral yon-Federal r+ine <br />aroposed thange in: `"" ~- <br />sturbed Area (+/-) Acres Affected Area (+/_) Acres <br />rermit Area (+/-) ` - ` `Acres Federal Land (+/_) -' -' ` -Acres <br />State Land (+/_) - ` -~- Acres Private Land (+/-) _ Acres <br />6185E (Rev. 10/881 - _ - - _ <br />215 Centennial i3uitdrq, 17tJ Snem+an Street Denver. Goiora0o-B0207.2273 Tei.1700 866 356 7 <br />