REV88227

• Permit No: C1992080
• IBM Index Class Name: Revision
• Doc Date: 7/25/1996
• Doc Name: APPLICATION FORM FOR A REVISION TO A COAL MINING AND RECLAMATION PERMIT
• Type & Sequence: TR5
• Media Type: D
• Archive: No

III II111111111111N
DIVISION OF MINERALS AND GEOLOGY
DeVanmem of Natural Resources
I) 13 Sherman SL. Room ? 15
STA
JUL 2~ 1996
Denver, Colorado BO?03
Phone: [phone] Division of Minerals 8 Geology
FAX:13031 8l2 8106 APPLICATION FORM FOR A REVISION
TO A COAL MINING AND RECLAMATION PERMIT
DEPARTMEM' OF
NATURAL
RESOURCES
This form must be completed and submitted with all requests for minor revisions, as defined in Noy Romer
Rule 1.04(731, technical revisions, as defined in Rule 1.04(136), and permit revisions, as defined ewer"°'
in Rule 1.04(901. All revisions are to address the requirements of Rule 2.08.4. Three (3) copies S
'rc
e

of the revision, including maps, must be submitted in order for it to be complete. ve D
i°r
Etecu
c
Flichael B. Lonq
D~~'uion Dlrecbr
All revisions are to be formatted so they can be inserted into the permit to replace the revised
sections, maps, tables and/or figures, with a revised table of contents, if necessary. The revision submittal
date should be printed in the Iewer right corner of each revision page. A cover letter to the revisi on should
explain the nature of the revision and reference the specific permit sections being revised.
For federal mines, a copy of the revision application must be submitted to all agencies on the federal mailing
list at the same time the application is submitted to the Division, and proof of distribution must be submitted
to the Division along with the application. Copies of revision pages modified during the review process must
be distributed in the same manner, along with proof of distribution. Proof of distribution must be submitted
prior to implementation of the revision. For non-federal mines, a copy of the application for which the
Division has issued a proposed approval decision must be submitted to the OSM Western Regional
Coordinating Center (1999 Broadway Blvd., Suite 3320, Denver, CO 80202-57331, and proof of submittal
to OSM must be submitted to the Division prior to implementation of the revision.
Permit No.: C- g 2- O 8 0 Date: O~/? S/ 9 ~o
Permittee: Q ~ ~ ~ L ~ Ci ~ - E N E- ~/ G ~
Street: ? 3- ~- ~ ~~~.~J2 - ~ /~--
s~ 1L L L ~ - L g - - - - - - -
CitY: ~JL1~ g L`r ~2--------
State: ~ O Zip Code: 8 L 3 ~ L - - - - -
Brief Description of Revision: ,4 L % ~ 2 ~ ~ T f ~! ~ - P O
Public Notice Attached: Yes L No
Bond Increase: Yes - No
Proposed Change in:
~ S G S - - - - - - - - - -
(Required for PRs and TRsI
Federal - Non-Federal ~ Mine
Disturbed Area 1 +l-) - - ~ . -Acres
Permit Area I +l-) - - 12 . -Acres
State Land 1+/-) - - ~ . -Acres
Affected Area 1+/-) - - Q . -Acres
Federal Land 1 +1-) - _ ~ . -Acres
Private Land 1+/-) - _ Q . -Acres
m :1 c o a l \s h a re \ f o r m s\ 6 6 6 5