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l , STATE OF COLORADO DIVISION OF MINERALS AND GEOLOGY Departme~s of V~iunl Resources t 3 t) Sherman A ,Room 215 Denver, Cdorado 80307 Phone' 0031 6667567 APPLICATION FORM FOR A REVISION FAX. (,7077 633-6t06 TO A COAL MINING AND RECLAMATION PERMfT This farm must be completed and submitted with all requests for minor revisions, as defined in s,t, ~ Rule 1.04(731, technical revisions, as defined in Rule 1.04(1361, and permit revisions. as defined ~"~ in Rule 1.04(90). All revisions are to address the requirements of Rule 2.08.4. Three (3) copies yme.s ~t+..~d of the revision, inGuding maps, must be submitted in order for it to be complete. t1LO1~`o1i10` s~idssel 6.lag All revisions are to be formatted so they can be inserted into the permit to replace the revised ~'~ o.~. sections, maps, tables and/or figures, with a revised table of contents, if nettssary. The revision submittal date should be printed in the bwer right corrter of each revision page. A cover letter to the - revision should explain the nature of rite 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 dstribution 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 Albuquerque Field Office (AFO), and proof of submittal to AFO must be submitted to the Division prior to implementation of the revision. Permit No.: C - ~ ~ - ~ ~ Z Date: ~. 2 / L ~ l S ~ Permitt e: B A S I N R E S 0 U R C E S ' . ~F~FI~ED e __ _ _ _ ~Cl N E W E L K_ M I N E _~ ___ _ O b 995 Street: ,~ ~ 3_ 0~ _ J11 S_G~i W_a.~ ._1 Z. - - _iYision u( ~vunerd,s a ~eoiogy City_ W E_S T O N _____ _ State: C O Zip Code: 8 1 0 9 1 Brief Description of Revision: ICY D R o_ ~ Q~v~ 'Lp~, ]_i~sz _ - - if'1 Z~ ~' P L A N R E V I S I O N - -------- ------- Public Notice Attached: Yes ` No _ /Required for Plis and TRs) Bond Increase: Ves _ No X Federal _ Non-Federal ~ Mine Proposed Change in: Disturbed Area 1+/-) _ _ _ Acres Affected Area (+/-) _ _ _ _ Acres Permit Area (+/-) ~ _ _ _ Acres Federal Land (+/-) _ _ _ _ Acres State Land (+1-) ,_ _ _ Acres Private Land l+/-) ^ _ _ _ Acres m: \cod\sh rrre\ fo rm s1B8 B 5