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STATE OF DIVISION OF MINERALS AND GEOLOGY Departmem d Natural Resources OV I ~ ,~ ~r 1 Jl l Sherman 51.. Roam 215 1: Denver. Colorado 8020) Phone: \3031866.3567 wi~lofl tll Mine(al$ if F.~x: \303\ e3z•alor, APPLICATION FORM FOR A RE1i'ISI01~ TO A COAL MINING AND RECLAMATION PERMIT This form must be completed and submitted with all requests for minor revisions, as defined in aw au„er Rule 1.04(73), technical revisions, as defined in Rula 1.0411361, and permit revisions, as defined ~OYe11Of in Rule 1.04(901. All revisions are to address the requirements of Rule 2.08.4. Three (31 copies E "~ s~ o me of the revision, including maps, must be submitted in order for it to be complete. .,,~h.N e. lcnc ~Itl1110n OirR,Ur All revisions are to be formatted so they can be inserted into the permit to replace the revised sections, maps, tables and/or figures, with a revised table of contents, if necessary. The revision submittal date should be printed in the lower right corner of each revision page. A cover letter to the revision should explain the nature of the revision and reference the specific permit sections being revised. For federal mines, a copy of the revision application must be submitted to all agencies on the federal mailing list at the same time the application is submitted to the Division, and proof of distribution must be submitted to the Division along with the application. Copies of revision pages modified during the review process must be distributed in the same manner, along with proof of distribution. Proof of distribution must be submitted prior to implementation of the revision. For non-federal mines, a copy of the application for which the Division has issued a proposed approval decision must be submitted to the OSM Western Regional Coordinating Center (1999 Broadway Blvd., Suite 3320, Denver, CO 80202-5733), and proof of submittal to OSM must be submitted to the Division prior to implementation of the revision. Permit No.: C- 8 2 - 0 5 6 Date: 7 Q 1 0 8 1 9 6 Permittee: T W E N ~ Y ITV _ I ~ E _ _ _ _ _ _ C O ~~_ C O M P A N ~___ Street: 2 9 5 1 5 R O U T T_ C O U N T Y R Q A D_ # 2 ~_ _______ City: O _~ K_ C R E E K ______ State: C O Zip Code: 8 0 4 6 ~ - _ , _ _ Brief Description of Revision: SELF-CLEANING MAGNETS AND TEMPORARY CONVEYOR BELTS Public Notice Attached: Yes _ No X (Required for PRs and TRs) Bond Increase: Yes X No_ Federal X Non-Federal _ Mine Proposed Change in: Disturbed Area (+/_) _ _ 0 0 Acres Affected Area (+l-) _ _ 0 0 Acres Permit Area (+/_) _ _ 0 0 Acres Federal Land (+l-) _ _ 0 0 Acres State Land (+!-) _ _ 0 0 Acres Private Land (+!-) _ _ 0 0 Acres m•\rnal\charc\fnrms19865