REV96562

• Permit No: C1984065
• IBM Index Class Name: Revision
• Doc Date: 6/6/1991
• Doc Name: APPLICATION FORM FOR A REVISION TO A COAL MINING AND RECLAMATION PERMIT
• Type & Sequence: RN2
• Media Type: D
• Archive: No

III IIIIIIIIIIIII III STATE OF COLORADO
. \•`~~ Roy Romer, Gove
lx v6
DEPARTMENT OF NATURAL RESOURCES
MINED LAND RECLAMATION DiVIS10N
FRED R. BANTA, Director APPLICATION FORM FORA REVISION
TO A COAL MINING AND RECLAMATION PERMIT
This form must be completed and submitted with all requests for minor revisions, as defined
in Rule 1.04(73), technical revisions as defined in Rule 1.04(36) and permit revisions, as
defined in Rule 1.04(90). All revisions are to address the requirements of Rule 2.08.4.
Three copies of your revision including maps must be submitted in order for it to be complete.
All revisions are to be formatted so they can be inserted into the permit to replace the
revised sections, maps, tables and/or figures. Explain in the revision what section is being
revised. The revision date should be printed in the lower right corner of the revision
pages. If necessary, the Table of Contents should also be revised. When the final version
of the revision is approved, 7 copies must be sent to OSM in Denver for Federal mines and for
non-Federal mines 1 copy must be sent to OSM at 625 Silver Avenue, SW, Suite 310,
Albuquerque, New tdexico 87102. The revision may not proceed until OSM has been provided
copies, Copies should be sent certified mail.
Date: _0:6 /:OS _ / 91 _
Permittee: N C I G F' I'N
A N-C I A L' I-N -C
_
~~ ~ F~ECEIVEC~
~reet: 7
- 4 7 6
- - - E A R K A N S A S
- - - - - - - - - - -
N
- o l
--- o o ________
--- JUN 61991
City: D E N V E R
--ddlined Land
state: 0
- 0 Zip
- Code: 8 0 2 3 1
- - .._ - . - - - Reclamation Division
Permit }lti,: C- 8 4- 0 6 5
Mine Name: C O A L R I D G E # 1
rs box to be filled in by the Division:
Type of Re vision: _ _ (PR, TR, or MR )
Revision Number: (Sequential by Revision Type)
Rev. Submittal Date: _ _/_ _/ _ _ (Date Received by Division)
Rev. Completeness Date: _ _/^ _/_ _ Rev. Incanpleteness Date: ~_ _/_ _/_
Rev. Adequacy Due Date: _ _/_ _/_ _ Rev. Adequacy Date: _ _/_ _/_ _
Rev. Decision Due Date: _ _/_ _/_ _ Lead Reclamation Specialist: _ _ _
rier escrip ion or evision: L
- o A D o v T
- - - - - - - - - - - - - -
F A C I L I T Y
Publi c Notice Attached - Yes x ~! o (Ttequi red 1'or~R's and~R s )
Bond Increase: Yes No X F-'-3e eral Non-Federal x Mine
~oposed Change in:
sturbed Area (+/-) + 4 4 Acres Affected Area (+/-) + 4 4 Acres
hermit Area (+/-) - + q ,q Acres Federal Land (+/-) - - - - Acres
State Land (+/_) - - - - Acres Private Land (+/-) _- '+ 4 .9 Acres
6185E (Rev. 10/88)
215 Centennial Building, 1313 Sherman Street Denver, Colorado 80203.2273 Tel. [phone]