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• • III IIIIIIIIIIIIIIII <br />999 <br />STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources .~oepco~4 <br />1313 Sherman St., Room 215 ~ ~; ~~ , <br />Denver, CO 80203 .bap <br />Phone: 1]031 866-3567 ~ X6)6 <br />FAx: f303) 832-8106 <br />APPLICATION FORM FOR A REVISION Ruy Romer <br />TO A COAL MINING AND RECLAMATION PERMIT cove`"°` <br />mrchacl B. LnnR <br />Division Direclur <br />This form must be 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(136) 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, the Federal operation is responsible for providing one copy to each <br />of the agencies noted on the Federal Agencies Mailing List. For non-Federal <br />mines, the operation is responsible for providing one copy to OSM in <br />Albuquerque (625 Silver Avenue, SW, Suite 310, New Mexico 87102). The <br />revision may not proceed until OSM has been provided copies. Copies should be <br />sent certified mail. <br />Permit No.: C - ¢ L - O ~ 5 <br />Date: ~ (a/ ~~/ g <br />Permittee: ~ p~`r iQ y g ~ - ~ L ~ g - - <br />~ciz~-~---------J-- <br />Street: ~~~- 1 ~ -------- <br />- - - - - - - - - - - - - - - <br />State: S ~ Zip Code: .$ ~ 3 ~ ~ - - - - - <br />Mine Name: ~i111~-~~~~-_______ _- <br />Brief Description of Revision: ~ ~ ~ ~ ~ ~ - ~ ~ ~ ~ ~ - ~ v~ <br />L~u~sL~~S ~L~i.lU~-- <br />---------------- <br />Public Notice Attached - Yes ~ No (Required for PR's and TR's> <br />Bond Increase: Yes No ~ Federal ~ Non-Federal Mine <br />Proposed Change in: <br />Disturbed Area (+/-) <br />Permit Area (+/-) <br />State Land (+/-) <br />6185E (01/93) <br />_ _ _ Acres <br />Acres <br />- -'- <br />- - Acres <br />Affected Area (+/-) <br />federal Land (+/-) <br />Private Land (+/-) <br />_ _ _ Acres <br />11~ - - Acres <br />f/J - - Acres <br />