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.i..eSw...s.n:. •....~la-CaJ-C.el.S.4a,w[:vL.as:v~.y.~...i:ve,au_~......y.... <br />z <br />. G~ <br />STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY /~, _IVED <br />Department OI Nalurdl ReSOUrceS R~1 F <br />I i 13 Sherman St.. Room 215 NOV 13 1995 <br />Denver, Colorado 80207 <br />Phnne: i307186h-3567 <br />FAX: 13031 83 2-8106 APPLICATION FORM FOR A REVISION <br />TO A COAL MINING AND RECLAMATION cerals 8 Geolo DEPARTMENT OF <br />sr NATURAL <br />RESOURCES <br />This form must be completed and submitted with ali requests for minor revisions, as defined in Roy Romer <br />Rule 1.04173), technical revisions, as defined in Rule 1.04(1361, and permit revisions, as defined coverrpr <br />in Rule 1.041901. All revisions are to address the requirements of Rule 2.08.4. Three 13) copies e.'^e: Ve o!'~°od <br />of the revision, including maps, must be submitted in order for it to be complete. <br />Michael8 Long <br />Drvninn Direaur <br />All revisions are to be formatted so they can be inserted into the permit to replace the revised <br />sections, maps, tables and/or figures, with a revised table of contents, if necessary. The revision submittal <br />date should be printed in the lower right corner of each revision page. A cover letter to the revision should <br />explain the nature of the revision and reference the specific permit sections being revised. <br />For federal mines, a copy of the revision application must be submitted to all agencies on the federal mailing <br />list at the same time the application is submitted to the Division, and proof of distribution must be submitted <br />to the Division along with the application. Copies of revision pages modified during the review process must <br />be distributed in the same manner, along with proof of distribution. Proof of distribution must be submitted <br />prior to implementation of the revision. For non-federal mines, a copy of the application for which the <br />Division has issued a proposed approval decision must be submitted to the OSM Western Regional <br />Coordinating Center 11999 Broadway Blvd., Suite 3320, Denver, CO 80202-57331, and proof of submittal <br />to OSM must be submitted to the Division prior to implementation of the revision. <br />Permit No.: C-~ Z-~~~ Date: 1 1/ 0 9 1 9 5 <br />Permittee: Z $ ~ ~ Z ~ 1L $ ~ ~ - C_ 0_ A_ ~ <br />C 0 ~? $ IL $-------- <br />Street: 2 9 5 1 5- R 0 U T T -$ g- <br />ll 2 7 <br />City : 0 A t~ - $ ~ ~ ~ ~ - - - - - - <br />State: ~ ~ Zip Code: $_ 2 ~ fi_ L - - - - - <br />Brief Description of Revision: W A S T E- P I L E- C 0 N S T <br />R U C T I 0 N_ S C H E D U L ~ (~ ~~~ L Q J~ ~R <br />P L A N T_ I N S T <br />Public Notice Attached: Yes <br />Bond Increase: Yes X No <br />Proposed Change in: <br />A L ~~L1.0-~L---- <br />No X (Required for PRs and TRs! <br />Federal X Non-Federal - Mine <br />Disturbed Area (+ I-) 0 0 Acres <br />Permit Area (+/-) - - 0 0 Acres <br />State Land (+/-) 0 0 Acres <br />Affected Area (+/-) - - ~ . ~ Acres <br />Federal Land (+/-) - - ~ . ~ Acres <br />Private Land (+/-) - - ~ . ~ Acres <br />