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s <br />06-02-2009 01 ~ 44PM FROM III I II I II I II IIII III TO 3038328106 P. 04 <br />999 STATE OF COLORADO <br />DIVISION OF IMIN6tAL5 AND GEOLOGY <br />OeWrtnerM d Naomi Rl90v0lS <br />131 ]Shaman 51- Room 27 S <br />Denver. Colorado 80203 ~ . <br />I+hpie~ 1303)8663567 <br />FAx: 13031832.8106 APPLICATION FORM FOR A REVISION <br />TO A COAL MININQ AND RECLAMATION PERMIT 17I?PAAT'MBNT <br />RESOUR~ <br />This form must be competed and submitted with all requests for minor revisions, es defined in sac acme <br />Rule 1.04173), technical revisions; es defined in Ruts 1.04(136), and pertnh revisions, as delklad ~^~ <br />in Rule 7.04(90). All reViaiOrla are to address the requlremer-ts of Rula 2.08.4. Three (31 copies Fame S ~+~ <br />of the revision, including mega, must bs aubmttted in order for it to be complete. rJ1°1tl1Y ol'°° <br />Mkhael & lpe <br />Ap revisipna aro to be formatted so o~eno.e~a <br />they can be inserted into the permit to reptaee the revised <br />sections; maps, tablaa and/or fpurss, with a revised table of contents, if neeessery. The revision <br />submittal date should be printed in the lower right corner of each revision pope. A cover letter to the <br />revision should sleplain the nature of the revlsbn and refererlee the spedflc permit sections being revised. <br />e <br />for federal mines, a copy of the revision application must be submitted to alI agencies on the federal mail'mp <br />list at the same time the application is submitted m the Division, and proof of distribution must be submitted <br />to the Division atone with the application. Copies of revision papea modified during the review process must <br />be distn'buted in the same manner, sloop vvidl proof of distributon.- Proof of distribution must be submitted <br />prior to implarrletltadon of the revision. fvr non-federal mines, a copy of the appNcadon for which the <br />Division has iasuad a proposed approval decision must HO submitted to the OSM Albuquerque Feld Office <br />(AFOI, and txoot of submittal to AFO must ba submitted to the Division prior to implememation of the <br />revision. <br />Permit No.: C-~~ - D 8 Q Date: Q (~ l~ 1/ O Q <br />Perrrlittee: Q ~ K ~ ~ ~ ~ ~ - ~ .ht ~ S~ ~L <br />Street: ~~ I ~- _,~ g~1~~$Q~Q- <br /> <br />Citye j ~L1~.~i.~tg- ~A~S~ S-- <br />Stats: Z ~ Zip Code: ~ ~ ~, Q y - - - - - <br />Brief Dssedpdon of Revision:- C ~1 ~A, ~ ~ ~ _ IL )~ ~ L 'D ~ ~ T <br /> <br />Pubfie Nodee Attached: Yes _._, No X (Required for PRs and 7'Rsl ! - - - ~ r <br />Bond Increase: Yes _ No ~ Federal ._ Non-Federal ~ Mine <br />Proposed Change in: <br />Disturbed Area (+/-) _ _ Q . Q Acres Affected Area (+/-) - - .Q . Q Acres <br />Permit Area (+/-) _ ~ ~ . Q Acres Federal Lend (+!-) ,~ ~ ~ . Q Acres <br />State Land (+ /-1 _ _ Sj • ~ Acres Private Land (+ /-) - _ O . Q Acres . <br />O <br />m:lcod\~h~ra\rorms~a806 <br />