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<br /> <br />STATE OF COLORADO <br />Roy Romar. Gove~ <br />DEPARTMENT OF NATURAL RESOURCES <br />MINED LAND RECLAMATION DIVISION <br />FRRO R. BANTA, Dlnetet <br />APPLICATION FORM FOR A REVISION <br />TO A COAL MINING AND RECLAMATION PERMIT <br />This form must be completed and submitted with all requests for minor revisions, as defined <br />in Rule 1.04(73), technical revisions as defined in Rule 1.04(36) and permit revisions, as <br />defined in Rule 1.04(90). A11 revisions are to address the requiremenu of Rule 2.09.4. <br />firee 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 />revtsed sections, maps, tables and/or figures. Explain in the revision what section is being <br />revised. fie revision date should be printed in the lower right corner of the revision <br />pages. If necessary, the Table of Contents should also De revised. When the final version <br />of the revision 1s approved, 7 copies must be sent to OSM in penver for Federal mines and for <br />non-Federal mines 1 copy must be sent u OSM at 625 Silver Avenue, SN, Suite 310, <br />Albuquerque, Hew Mexico 87102. The revision may not proceed until OSM has been provided <br />copies. Copies should be sent certified mail. <br />Date: 4-/ 2s / ~~ <br />Permlttee: g~itl~.~o~•.~~~Si~C_. -- - - - - - <br />MARD lIII~R,.,,, _.._. - .-. - .~. _ - - <br />StreeL: DOR 4~7---`-------- <br />City: WALDLI~------------------ <br />State: co Zip Code: aoa9~ - - - - - - <br />Permit No.: C - ' <br />s ox e e n y a tv ston: <br />type of Revision: ~ _ (PR, TR. or MR) <br />Revision Number ~ - (Sequential by Revision Type) <br />Revision Submittal Date ~/~/g3 (Date Received by Division) <br />Revision Completeness Date -/-/ Revision Incompleteness Date _/ /- <br />Revision Adequacy Due Date -/-/ Revision Adequacy Date -/ / <br />Revision Decision Oue Date / / Fee 50.00 <br />Brief Description of Revision: .6i3A~&IfBAGT.~IAOt~_Nppp~~{rrr,~~~~2~,~~,3;~z2, <br />Public Notice Attached -Yes - ~Io ~-(ltequ~re~r~R~s andZRT) - <br />Bolld Increase: Yes No ~_ ~eaeral g Non-Federal Mine <br />Proposed Change 1n: <br />Disturbed Area (+/-) Acres Affected Area (+/-) ~,,,p,.~„ Acres <br />Permit Area (+/-) - "- a~ Acres Federal Land (+/-) _ - ~,p Acres <br />State .land (+/-) - -r ~ ,, p Acres Private LanO (+/.) 0 Acres <br />Lead Reclamation Spec~al~t,~~ _ 6165E (1~ev-2~8) <br />..423 Centennial Bulidinp, t3t3 Sharman SVeet Denver, Colorado 80203.2273 TeL (303) 888-3387 <br />£0'd 6T0'oN S£~9T £6. 9Z ?JdH <br />8b066L8£0£~QI <br />' ' JNI ZJti <br />