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L <br />STATE OF COLOR-ADO <br />MINED LAND RECLAMATION DIVISION <br />DeDanment of Natural Resources <br />13t 3 Sherman St.. Room 215 <br />Denver. CO 80203 <br />303 866-3567 <br />Fax: 303 832-8106 <br />pF' p0~ <br />s <br />„`'rem C'1~ <br />. ~ . <br />R <br />~1a76 <br />Rq ftongr, <br />Ga+emor <br />Free R. Banta <br />APPLICATION FORM FOR A REVISION Ohision 0oector <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 - 81 - X1,1 - <br />Date: 10-/ 29 / ~- ~~ ~- ~ ~ ' <br />Permittee: ENERGY FUEI~S~O~,_„~~.---~~_ `~~ ~/ <br />--------~~- ~,199L <br />Street: P.O. Box 449 <br />- - - - - - - - - - - - - - - <br />_ _` .:~,, <br />City: Florence ---------------- <br />State: CO Zip Code: ~~~ - - - - - - <br />Mine Name: Southfield Mbnq~------------,- <br />Brief Description of Revision: 1,3ep~U.~e~oa~~,ctensi~n- - - - - - <br />Public Notice Attached - Yes No _~. (Required for PR's and TR's) i <br />Bond Increase: Yes No _~ Federal Non-Federal X Mine <br />Proposed Change in: <br />Disturbed Area (+/-) _ _ 0 , 0 Acres Affected Area (+/-) _ _ 0.0 Acres <br />Permit Area (+/-) - - ~.~ Acres Federal Land (+/-) - - - Acres <br />State Land (+/-) Acres Private Land (+/-) 0.0 Acres <br />c,st~r rinioni <br />