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III IIIIIIIIIIIIIIII <br />STATE OF COLORADO <br />MINED LAND RECLAMATION DIVISION of =~ <br /> <br />Department of Natural Resources ~ <br />ce~~~~ <br />~ <br /> <br />1313 Sherman St.. Room 275 <br />Denver, CO 60203 N <br />~ to <br />~ ^ <br /> <br />303 866-3567 . <br />. <br /> <br />Fax: 303 832-Bt06 raga <br /> Roy Ramer. <br /> Govenpr <br /> ' Freo R. Barra. <br />APPLICATION FORM FOR A REVISION t)IVISiOn Orrenor <br />TO A COAL MINING AND RECLAMATION PERMIT <br />This form must be completed and submitted with all requests for minor <br />revisions, as defined in Rule 1.04(73), technical revisions as defined in <br />Rule 1.04(36) and permit revisions, as defined in Rule 1.04(90). All <br />revisions are to address the requirements of Rule 2.08.4, Three (3) copies of <br />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 <br />replace the revised sections, maps, tables and/or figures. Explain in the <br />revision what section is being revised. The revision date should be printed <br />in the lower right corner of the revision pages. If necessary, the Table of <br />Contents should also be revised. When the final version of the revision is <br />approved, 7 copies must be sent to OSM in Denver for Federal mines and for <br />non-Federal mines 1 copy must be sent to OSM at 625 Silver Avenue, SW, Suite <br />310, Albuquerque, New Mexico 87102. The revision may not proceed until OSM <br />has been provided copies. Copies should be sent certified mail. <br />Permit No.: C - 8 4 - ~ ~ ~, <br />Date: 0 8 / 1 3 / ,~ ,~ <br />Permittee: N ~ ~ ~ - i ~ ~ ~ ~ ~ Z g ~ L N C. <br />Street: 7975 East Ar]La;},~a~P,yeny~ ~Q~ - - <br />city: D~~-°=~--~---------~---- <br />State: ~ Q Zip Code r ~ ~ .2. i 1 - ~ ~ ~ 2 <br />Mine Name: ~p~+,11~,1RC~-rLO"1--------- <br />Bri of Descri pti on of Revision: ~ ~~~ ~ ~F-.soiLpile~ ~~~~, - <br />design of cosl waste disposal facility <br /> <br />Public Notice <br />Attached - <br />Yes - <br />X._ - - - - - - - - - - - <br />No __._. (Required for PR's and - - - - <br />TR's) <br />Bond Increase: Yes No x Federal Non-Federal ~ _ Mine <br />Proposed Change in: <br />Disturbed Area (+/_) _ _ _ _ Acres <br />Permit Area (+/-) _ ~ Q.,~ Acres <br />State Land (+/-) Acres <br />6185E (10/90) <br />Affected Area (+/-) _ _ _ _ Acres <br />Federal Land (+/-) _ _ Acres <br />Private Land (+/-) Acres <br />