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STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY ~E~~11/~~ ~ <br />Department o(Natural Resources h~o>• CO ~ <br />r "~ <br />1313 Sherman St., Room 215 1~~ ~ ~ww a .~ ~ <br />Denver, CO 110203 ~ vJ y~ <br />Phone: (3031 866-3567 ~ reps ~ <br />FAX: 1303)832-8106 r~ p Roy ROmer <br />L'ivi,]iorl of 11111~BYdIS 6 GBCICQy Governor <br />APPLICATION FORM FOR A REVISION Micnae~B. long <br />TO A COAL MINING AND RECLAMATION PERMIT DivisionDirenor <br />This form must be completed and submitted with all requests for minor revisions, as defined in <br />Rule 1.04173), technical revisions, as defined in Rule 1.04(36), and permit revisions, as defined <br />in Rule 1.04(90). All revisions are to address the requirements of Rule 2.08.4. Three (3) <br />copies of your revision, including maps, must be submitted in order for it to be complete. <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. Explain in the revision what section is being revised. <br />The revision date should be printed in the lower right corner of the revision pages. If <br />necessary, the Table of Contents should also be revised. When the final version of the revision <br />is approved, seven copies must be sent to OSM in Denver for federal mines; for non-federal <br />mines, one copy must be sent to OSM at 505 Marquette Avenue NW, Suite 1200, <br />Albuquerque, New Mexico 87102. The revision may not proceed until OSM has been provided <br />copies. Copies should be sent certified mail. <br />Permit No.: C- 8 L- Q 2 <br />Date: O ~ / ~ ~ / 9 4 <br />Permittee: 5 ~ .L7 - C O A L - L' Q - - - - <br /> <br />Street: - <br />L - <br />Q - - - <br />Z O O - <br />- - <br />W. - - <br />- 4 - <br />4 - - - - - <br />? H--- <br /> A V E.-~ = ~ -L z 8 ---- <br />city: ~- ~ QP~ Z - I~ L~ S~ E ---- <br />State: ~ Q Zip Code: ~ Q O 3 ~ - - - - - <br />Brief Description of Revision: C L +, j~ ~ ~ L ~ A L ,~ Q 1~ <br /> Q~- ~~~L1~..LI L.~~- <br /> <br />Public Notice Attached: Yes ~ No - (Required for PRs and TRsI <br />Bond Increase:.Yes - No ~ Federal - Non-Federal ~ Mine <br />Proposed Change in: <br />Disturbed Area (+/-) - - Q . O Acres Affected Area (+/-) - - Q . O Acres <br />Permit Area (+/-) - - Q . Q Acres Federal Land (+/-) - - ©. ~ Acres <br />State Land (+!-) - - Q . Q Acres Private Land (+/-) - - ©. O Acres <br />m: \wel\a hors\forrn a\rev. app <br />