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III Iiilillllllii III <br />sTA~ of co~o~o <br />r•~ <br />Roy ROn1ff, 6ova,rwr <br />.. <br />DEPARTMENT Of NAT~lRAL HESOUNCES "~ <br />MINED LAND RECLAMATION DMSION :;~ ""'1' ~ .- <br />r<nao r< au-arrwr or..a.. NpLICATI011 FoNI FOE A EEI1ISId1 '-- ~ ~ ~' = <br />' TO a COYLL fI1MlRi AID REClAf11TIa -ERMIT <br />This fora swst be capleted and suEmftted t-1th all ragrests for a~inor ndsfons, as define: <br />in Rule 1,04(73), technical recisions as defined fn Rule 1,04Cl6) and pensit revisions, as <br />Oeftned in Rule 1,04(90), All recisfoAS an to addross t:he reauframents of Rule 2,08.4, <br />Three copies of your recision including !naps must Oe submitted in order for it to De complete. <br />A11 revisions are t0 De fonaattad fo they can be taserted into tM permit to replace the <br />reviseC sections. maps, tables and/or figures, Explain in the recision rMt section is Deep= <br />revised, The revision date should be printed in tpe lower right corner of the revision <br />gages. If necessary, the Table of Contents should also De revised. i,hen the final versldn <br />of Lhe revision is approved, J copies must De sent to OSM in Denver for Federal mines a~? `: <br />non-Federal mines 1 copy must be serK to OSM at 625 Silver Ayenue, 511, Spite. 310, <br />~ A1DUQuerque, Mew lkxico 81102. fie revision mqr not proceed until OSM has been provided <br />copies. • Copies should be sent cenlfied mail. <br />Date: _ ~/ ~ 2/ <br />~enntttee: ~~S ~ N _ ~So_ ,ems _ RECFIVFn <br />~.~ .....r. r.. <br />,tireet: / ~l 3 L? O ~. G/yGU~,r_/L UUN 20 1994 <br />;, f ty: u~~s 7C oCJ Division c! Afirerai, u <br />State: ~ C~ Zip tede: ~ (d ~ f' - . <br />~-~~_ <br />IAine !Jame: G~ C. ~~G_~!~GL ~_____ _,_ <br />is ox o e ~n y e ~ son: <br />Type of Revision: ~ ~ iPR, TR. or /R ) <br />Revision Number: ... _ (SequerKial Dy Recision Type) <br />Rev, Submittal Oate: _ _/ _/ (Date Received by Derision) <br />Rev, tompl eteness Date: _, _/ _/ _ Rer; Irrcowpleteness Date: _ `/ ,,,,/~ _ <br />Rev, AdeQUaey Due Oate: _ _/ _/ _ Rer, Adepuacy Date:.. _/_ ~/ _ <br />Rev, 4eclsion Due Date: _ _/_ _/ _ Lead Reclamation Specialist: _ <br />vie escnp ion o ev~sron: ~ _ _ ~+t1fsd~~_ ~ = _ ~,,~~, ~.~ <br />N~l~s G~-s~z ~ ~c-~ s' <br />Public Notice Attached -Yes "Tfo~c (~a+iro'a ~r~R s and s) Mir <br />Bond Increase: Yes X 110 - ode and !Jon-Federal <br />proposed Change in: <br />1 sturbed Area (*/-) Acres Aftected Area 1+/.) _ _ _._ Acres <br />rennet Area (+/-) - - -.- Acres Ftderel Land (*/-) _ Acres <br />State Land (+/-) - - -' -Ades Priwte Land (*/-) _ _ _~ Acres <br />6185E (Rev, 10/88) - - _ <br />2 t 5 Gengnn7al 8uildinp, t~t3 SMerwrrn Sueat pincer, COIO,ado-B0207.227J 1e1,70J1 a66~9567 <br />