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Ill IIillllllllll Ill <br />STATE OF COLORADO <br />1 •~•~: ~ ~~• Roy Romar. Oorarnor <br />•~ <br />DEPARTMENT OF NATURAL RESOURCES ,~ <br />MINED LArID RECLAMATION DIVISION ;:•~ ~~"r' <br />R11aD R. aA1fTA, pweM- APPLICATION FO(MI FOR A REi~ISIOM ~ •' <br />TO A COAL MiaQRB AID RECLAMATION PERMIT <br />fits form oust be co>tpieted and su0iaitted tAtA ati reouests for minor nrisions, as define: <br />in Rule 1,04(13 ), technical nrisions as defined in Rule 1.04(36) and permit revisions, as <br />defined in Rule 1.04(90)• A11 nrlsions are to address the reauireaents of Rule 2.08.4. <br />Three copies of your nrision including aps must De submitted in order for it to De complete. <br />All revisions an Lo bt formatted so they can be inserted into tht persit to replace iha <br />revised sections, maps, tables and/or figures. Explain in the recision uWt section is Dein; <br />revised. The revision date should be printed in the lower right corner of the revision <br />gages. If necessary. the Table of Contents should also be revised. 711ten the first version <br />of Lhe revision is approved. 7 copies must De sent to OSM in Denver for Federal mines am j;r <br />non-Federal mines 1 copy oust be sent to OSN at 625 Silver Avenue, SW, Suite 310, <br />Albuquerque, New Hexico 81102. The recision ~ eoi proceed until OSM has been provi7ed <br />copies. Copies should be sent fortified taail. <br />Oate: ~/ ~/ ~ Y" <br />pe-mittee: ~~S / N - ~So~,e ~s <br />- - <br />- --- <br />,treet: / ~ 3 DO ~ G/flci~F1'-/L RFCE11/ED <br />- ----- <br />C i ty: GlJf=S 70 oc.J _ _- - - SUN 9 ]9~•4 <br />Sute: ~ L~ Zip Code: ~ (d ~ ~ • _ - ~ <br />- .- - - ~~ri o~ In~nerais w Goo~rgY <br />?ermtt llo.• t -81 - O ~ 3 <br />dine Name: Gam, L ~L /J-{~~f-L L ~ --- <br />~ is ox o e t e in y e t store: <br />Type of Revision: ~~ (PR, TR, or MR) <br />Revision !lumber: - - (Sequential Dy Recision Type) <br />Rev. Submittal Date: / / (Doty Received Dy Dtrision) <br />----.~- <br />Rev. Completeness Date:...-/ / - Rer. IMOapleteness Date: , / -/_ - <br />Rev. Adequacy Due Oete: - -/ _/ - Rer. Adequacy Date: _ -/, _/ - <br />Rev. Oeclsion Due Date: / / Lead Reclamation Specialist: <br />-- - ---- <br />Wrier ~escrtptaon or Icenston: ~~ ~ = ~ ~d w -o~- ~c~_,{~_ _ <br />public Notice Attached -Yes -Ro -(i~equin-8 or~R s and-TR s) Mfg <br />Bond Increase: Yes ~ llo ~. ~atil __ Non-Federal <br />proposed Change in: <br />sturbed Ana (+/•) Acres Affected Area (+/-) _. Acres <br />rentlit Area (+/-) - ` -.` Acns Federal Land (+/-) _ - - Atns <br />Stste Land (+/-) - '- "Ayes Prf wte Land (+/-) -" _ _ Acns <br />6185E (Rev. 10/88) - ' - <br />2t5 Centennial BuilWnp, t~t1 ~ annan Slraet Oanver, ColoradaBOYO]•227~ Tetl~o]I5661567 <br />