REV97648

• Permit No: C1981012
• IBM Index Class Name: Revision
• Doc Date: 11/16/1993
• Doc Name: APPLICATION FORM FOR A REVISION TO A COAL MINING AND RECLAMATION PERMIT
• Type & Sequence: MR56
• Media Type: D
• Archive: No

III Illillllllllllll a STATE OF COLO[~ADO
ass ~~
~~; .a0ic ~'8
•(: ~ ~• Roy Romer. Governor
~ -,
i '' ~
DEPARTMENT OF NATURAL RESOURCES ~ ~~
MiNED LAND RECLAMATION DIVISION ;~_~; `~~'
FRED R. BANTA, orr~cter APPLICATION FORH FORA REVISION ^ ~~~~~'
TO A COAL MINING AND RECLAMATION PERMIT
This form must be completed and submitted with all requests for minor revisions, as Refined
in Rule 1,04(73), technical revisions as defined in Pule 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.
A]1 revisions are to be formatted so they can be inserted info the permit to replace the
revised sections, maps, tables and/or figures. Explain in the revision what section is Dein;
revised. The revision date should be printed in the lower right corner of the revision
?ages. If necessary, the Table of Contents should also be revised. Nhen the fi^al version
of the revision is approved, 7 copies must be sent to OSp1 in Denver for Federal mines am ~~~
non-Federal mines 1 copy must be sent to OSM at 625 Silver Avenue, SW, Suite 310,
l,iDUquerque, New piexico 87102. The revision may not proceed until OSM has been provided
copies. Copies should be sent certified mail,
Date: ~ ~ / L ~/ ~'3 ////
permittee: ~~ ,s L ~- ~ ~S G~ U K~~-S
---------------
c;ty: ~~s ~ d :~; -------------
State: ~(~ Zip Code: _ - - - - - _ _ - _
Permit plo.: C - b'L - ~1 Z
dine dame: 1"~~~/- ~-------------
~s oox to oe rtt(ea ~n oy the o~vision:
Type of Revision: /~ /2 (PR, TR, or MR)
Revision plumber: _ - (Sequential by Revision Type)
Rev, Submittal Date: _ _/_ _ /_ _ (Date Received by Division)
Rev, Completen ess Date: - _/_ -/- - Rev, Incompleteness Date: - -/- -/_ -
Rev, Adequacy Due Date: - _/_ -/- - Rev, Adequacy Date: - -/- -/- -
Rev, Decision Due Date: - -/_ -/- - lead Reclamation Specialist: - _
rte escrip ion o eviston: ~ v (2 - - ~ / S - v L - C .
Publ i c ploti ce Attached - Yes o ~C ~ ~qui re ~ or~R s and-TR s )
Bond Increase: Yes Ilo ~ -F3era1 Hon-Federal ~_ !•?ine
oroposed Change in:
sturbed Area (+/-) Acres Affected Area (+/_) _ _ _ _ Acres
rermit Area (+/-) _- _- _- _- Acres Federal Land (+/-) _ _ _ Acres
State Land (+/-) _ _ Acres Private Land (+/-) _ _ _ Acres
6185E (Rev, 10/88) -'
215 Centennial Building, 13t 3 Sherman Street Denver, Colorado 802032273 7e1. (3031 8663567