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i <br />STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Depanment o! Natural Resources I~~~ <br />1313 Sherman St., Room 215 <br />Denver, Colorado 80207 <br />Phone: 1303) 866-3567 APPLICATION FORM FOR A REVISION <br />FAX: (303)832-8106 <br />TO A COAL MINING AND RECLAMATION PERMIT DEPARTMENT OF <br />NATURAL <br />RESOURCES <br />This form must be completed and submitted with all requests for minor revisions, as defined in Boy Romer <br />Rule 1.04173), technical revisions, as defined in Rule 1.04(1361, and permit revisions, as defined cow<*^ur <br />in Rule t .04(901• All revisions are to address the requirements of Rule 2.08.4. Three 131 copies lanes. L«hhead <br />of the revision, including maps, must be submitted in order for it to be complete. F:ecutive DirM« <br />Michael B. Long <br />Division Di,ector <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, with a revised table of contents, if necessary. The revision <br />submittal date should be printed in the lower right corner of each revision page. A cover letter to the <br />revision should explain 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 at the same time the application is submitted to the Division, and proof of distribution must be submitted <br />to the Division along with the application. Copies of revision pages modified during the review process must <br />be distributed in the same manner, along with proof of distribution. Proof of distribution must be submitted <br />prior to implementation of the revision. For non-federal. mines, a copy of the application for which the <br />Division has issued a proposed approval decision must be submitted to the OSM Albuquerque Field Office <br />(AFO), and proof of submittal to AFO must be submitted to the Division prior to implementation of the <br />revision. <br />Permit No.: C - 8 f - O ~ Q Date: .Q ~ / l ~ / 9 5 <br /> <br /> ~- -- - - - - - ---- - - RECEIVED <br />Street: L 1! ~ 12 Q - JeG• - 4. ~ T' if - ~ ~ AUG 31 1995 <br /> <br />City: W ~{ ~ ~ ~ Q ~ jz [~ ~ - - _ _ ~yision of M(nelals & Geology <br />State: C Q Zip Code: B a ss 3 3 - - - - - <br />Brief Description of Revision: F A ~ ~ ~ L L L ~ S - ~ ~ ~ <br />Public Notice Attached: Yes <br />Bond Increase: Yes _ No <br />No - (Required for PRs and TRsI <br />Federal <br />Non-Federal ~ Mine <br />Proposed Change in: <br />Disturbed Area (+ /-) - - Q . -Acres <br />Permit Area (+/-) - _ ~- . -Acres <br />State Land (+/-) - - Q . -Acres <br />m: \coal\sh are\fo rm s\6865 <br />Affected Area (+/-) - - Q . -Acres <br />Federal Land (+/-) 0 Acres <br />Private Land (+/-) - - Q . -Acres <br />