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STATE OF COLORf1D0 <br />~•~ <br />( <br />Roy Romer. Governor <br />DEPARTMENT OF NATURAL RESOURCES ~,,~~' <br />~ti~., <br />MINED LAND RECLAMATION DIVISION {i~~'`' <br />F11E0 R. BANTA, olnctor APPLICATION FORM FOR A REY ISIOM _:.!•' '~ ~' <br />TO A COAL MINING AND RECLAMATION PERMIT ~' <br />This form must be canpleted and submitted with all requests for minor revisions, as defined <br />in Rule 1,04(73), technical revisions as defined in Pule 1.04(36) artd permit revisions, as <br />defined in Rule 1.04(90). A11 revisions are to address the requirements of ?ule 2.08.4. <br />rnree copies of 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 replace the <br />revised sections, maps, tables and/or figures. Explain in the revision what section is bein; <br />revised. The revision date should be printed in the lower right corner of the revision <br />~~ages. If necessary, the Table of Contents should also be revised, when the fi^al versicn <br />of the revision is approved, 7 copies must be sent to OSIi in Denver for Federal mines an.! ~;- <br />non-Federal mines 1 copy must be sent to OSM at 625 Silver Avenue, SW, Suite 310, <br />Albuquerque, New Ftexico 87102. The revision may not proceed until p$M has been provided <br />copies, Copies should be sent certified mail, <br />Date: D ~/3 d / g ~/~ <br />Permittee: ,~~~~///~ 4~,.~l111.~1L.~ <br />,, <br />street: ~•~.~.QQ-L1..~ -~~--- <br />JUL 29 1993 <br />--------------- <br />~~ ~ ~ ~ -- n 1 JI IVIIIIGI4~~ N ~• ~i~]Y <br />State: Zip Code: Q ~ _ fJly•JI ~ <br />Permit Na,: C - ~ L - D L ~ -rr <br />I4ine Name: ~~ ~-~ [_~----------------- <br />is oox to oe rttlea to by the otvtston: <br />Type of Revision; - , (PR, TR, or MR) <br />Revision Number: - - (Sequential by Revision Type) <br />Rev, Submittal Date: - -/- -/- - (Date Received by Division) <br />Rev, Comp1 eteness Date: - -/- -/_ - Rev. Incompleteness Date: - -/ -/- - <br />Rev, Adequacy Oue Date: , -/_ -/ _ Rev, Adequacy Oate: - -/- -/ - <br />Rev, Decision Due Date: - -/ _/_ _ Lead Reclamation Specialist: _ - - <br />rte escrtp ton o evtston: ~ 1 ~ ~ _ ~ - _ - <br /> <br />bti <br />P <br />ti <br />h <br />tt <br />d b ~. ~ ,1~ .~~- Il ~~ <br />~R s a <br />dZR s)- - <br />ac <br />u <br />c No <br />ce A <br />e <br />- n <br />Yes o equtre or <br />Bond Increase: Yes No _ '~e'aeral Non-Federal !•!ine <br />proposed Change in: -' ` <br />sturbed Area (+/_) Acres Affected Area (+/-) Acres <br />rermit Area f+/_) - '- -' -Acres <br />- `Acres Federal Land (+/_) - <br />- <br />State Land (+/-) -' _ <br />_ <br />_ <br />Acres <br />Acres Private Land (+/-) <br />6185E (Rev. 10/88) _ _ <br />_ <br />- - <br />2 t 5 Cenlenniat 8ui lding, t3t3 Sherman Slreet Denver, Colorado 80203.273 Tel, {3031 866.3567 <br />