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~~ ~~ Of QCptO~ o DEPARTMENT OF NATURAL RESOURCES "~'~ DM INE~D LANDD~RECLAMATION DI1 ' x876 # DAVID C. SHELTON, Director R~coartl D. Lamm Governor APPLICATION FORM FOR A REVISION TO A COAL MINING AND RECLAMATION PERMIT This forth must be completed and submitted with all requests far minor revisions, as defined 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. All revisions are to be forrlatted so tfiey 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. Date: 1 2 / 1 ~/ ,g ~ Permittee: T R ~ p ~~3_~.L~.L1~~__ I N C _ _ _ _ _ _ _ _ _ _ Street: P 0 B O X 1 8 7 --------------- ,_i, r,C7 - - - - - - - - - - - - - - - C1ty: c x n I c ' State: c 0 Zip Code: 8 1 5 2 6- Permit No.: C - ~ 1 - Q i ~ This box to be filled in by the Division: Type of Revision: _ _ (PR, TR, or MR) Revision Number _ _ (Sequential by Revision Type) Revision Submittal Date _/_/ (Date Received by Division) Pevision Completeness Date _/ / Revision Incompleteness Date _/ / Revi si on Adequacy Due Date _/ /_ Revision Adequacy Date _/_!_ Revision Decision Due Date / / Fee E0.00 Brief Description of Revision: c_ x_ a N G E _T o s e e D_ - • M I X E S - - - - - - - - - - - - - - - - - Public Notice Attached - Yes _ No _ (Required for PR's and TR's) Bond Increase: Yes No Proposed Change in: Disturbed Area (+/-) _ _ 0._ Acres Permit Area (+/-) _ _ 0 ._ Acres State Land (+/-) Acres Lead Reclamation Specialist G x S Affected Area (+/-) _ _ 0 ._ Acres Federal Land (+/-) _ _ _ Acres Private Land (+/-) Acres 6185E 423 Centennial Fluilding, 1313 :.rierman Street Denver, Colorado 80203 Tel. (303) 866.3567