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_ Q - <br />~II II~II~II~II~~ II~ <br />COLORADO DIVISION OF MINERALS AND GEOLOGY <br />1313 Sberman Street, Room 215, Deaver, Colorado 80203, (303) 866-3567 <br />APPLICATION FORM FOR A REVISION .MPR `~'~ 199 eo'+~ <br />TO A COAL MINING AND RECLAMATION PERMIT ~.~~sot`o~M\c~et~sf4 <br />This form must be completed and submitted with all requests for minor revisions, as defined in Rule <br />t .04(731, technical revisions, as defined in Rule 1.04(1361, and permit revisions, as defined in Rute 1.041901. <br />All revisions are to address the requirements of Rule 2.08.4. Three (3) copies of the revision, including <br />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 sections, <br />maps, tables and/or figures, with a revised table of contents, if necessary. The revision submittal date <br />should be printed in the lower right corner of each revision page. A cover letter to the revision should explain <br />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 (except OSM) at the same time the application is submitted to the Division, and proof of distribution must <br />be submitted to the Division along with the application. Copies of revision pages modified during the review <br />process must be distributed in the same manner, along with proof of distribution. Proof of distribution must <br />be submitted prior to implementation of the revision. <br />Permit No.: C - _ Y I - 4 1 L Date: 0 3 _ / ?y_ / _~_ <br />Permittee: Q:cKet,„~:rc auraces57nq )vLG <br />11L U3 Se,.i-t, vl,r~. sf•,-«t S„3+~ Iz7d <br />Street: <br />City: 1Lz.. ~ rr <br />State: ~D Zip Code: rd023 7 - <br />Brief Description of Revision: E.1:."%~..~).. e~ St)p~l~+)d,. z~K~~ <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 (+/-) _ _ ~ . _ Acres <br />Permit Area (+/-) _ _ _Q . _ Acres <br />State Land (+!-) _ _ O . _ Acres <br />Affected Area (+/-) _ _ ~ . _ Acres <br />Federal Land (+/-) _ _ Q . _ Acres <br />Private Land (+/-) _ _ -~ . _ Acres <br />m:1 coallshare4lorms16865 <br />