REV97650

• Permit No: C1980001
• IBM Index Class Name: Revision
• Doc Date: 11/18/1992
• From: PITTSBURG & MIDWAY COAL MINING CO
• To: MLRD
• Type & Sequence: PR3
• Media Type: D
• Archive: No

STATE OF COLORADO
Roy Romer, Qovemor
DEPARTMENT OF NATUAAL RESOURCES
MINED LAND RECLAMATION DIVISION
reeo w. ttutNVa, otreetor
APPLICATION FORM FOR A REVISION
TO A COAL MI NI N6 AND RECLAMATION PERMIT
This fond must be canpleted and sudaitted with all requests far minor revisions, as
defined to Rute 1.04(73), technical revisions as defined 1n Rule 1.04(36) and
permit revisions. as defined in Rule 1.04(90). All revisions are to address the
requiretaents of Rule 2.08.4.
A11 revisions are to be foneatted so they can be insarted into the perntit to
replace the revised sections, maps, tables and/or figures. Explain in the revision
what section is being revised. fie recision date should De printed 1n the lower
right corner of the revision pages. If necessary, the Table of Contents should
also be revised.
Date: 1 1/ 0 4/ 9 2
Pennittee: T
- H E
- - P I T T S B U R G &
- - - - - - - - - - - -
M I D C O A L
P1 I N I
W A Y N
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Street:
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Cii<y: E N G L E IJ O O D _______ ____
State: C Q Zip Code: 8 0 1 L L- 4 9 9 1 p,11NERAL5 ~ ;,c,,

Permit
No.: C
- 8
0- 0 0 1 ._
s ox e e n y v s on:
type of Revision: _ _ (PR, TR, or MR)
Revision Nutaber _ _ (Sequential by Revision Type)
Revision Submittal Date / / (Date Received by Di vision)
Revision Completeness Date _%/_ Revision Incompleteness Date _/_/_
Revision Adequacy Due Date _/_/ Revision Adequacy Date _/_/ _
Revision Decision Due Date / / Fea 50.00
r e scr p ono ev s on: C~NILERLT~,Q J~h]P0R8Ety~Q~pLIC~IO~EBMA~(ENI..

Public Notice Attached - Yes X No (Required for PR's and TR's)
Bond Increase: Yes No X
Proposed Change in:
Dtsturbed Area (+/-) _ _ 0 0 Acres Affected Area (+/_) _ _ 0 0 Acres
Permit Area (+/-) _ _ 0 0 Acres Federal Land (+/-) _ _ 0 Acres
State Land (+/-) _ _ 0 Acres Private Land (+/-) _ _ 0 Acres
Lead Reclamation Special ist 6185E
a23 Centennial BuilGlnp, t373 Sherman Street Denver, Colorado 802034273 Tel. [phone]