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STATE OF COLOR-ADO <br />MINED LAND RECLAMATION <br />Department of Natural Resources <br />t3t3 Sherman St., Room 215 <br />Denver. C080203 <br />303 866-3567 <br />Fa x: 303 832-8106 <br />DEC 2 0 1991 <br />Mined Land <br />Reclamation Di~y~~t~. <br />APPLICATION FORM FOR A REVISION <br />TO A COAL MINING AND RECLAMATION PERMIT <br />OF CO(p <br />~6 9 <br />~~ %~18 <br />. C~::/~• <br />. C~Orr . <br />'re~a <br />Roy Romer. <br />Governor <br />Fred R. Banta, <br />Onision Dveclor <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 - ~ ~ - a 6 ,~ <br />Date: i b/ L o/ S i <br />Permittee: ~v G 1 ~ - F= ,r ~,~, ~ ,' ~ ~ - 7,. r, <br />Street: ? ~ ~ ~ - ~-- ~ 2 ,r ~ ~ s 8 S <br />/ c~ #- / v ~------- <br />c;ty: D ~_~~ ~ ~ ------------ <br />State: G ~ Zip Code: ~ 2 ~ ~ -L. - Z ~~ 3 <br />Mine Name: ~ D ~ Sc - ~ ! 72 ~z ~. _. °~ ° - ~ - - _ <br />Brief Description of Revision: ; ` c ,_. _,, ,' c ~ G - Q = +~ _s .OK <br />Public Notice Attached - Yes No _ (Required far PR's and TR's) <br />Bond Increase: Yes No yY Federal i Non-Federal ~ Mine <br />Proposed Change in: <br />Disturbed Area (+/-) _ _ _ _ Acres <br />Permit Area (+/-) _ _ _ Acres <br />State Land (+/-) - Acres <br />Affected Area (+/_) _ _ _ Acres <br />Federal Land (+/_) _ - _ Acres <br />Private Land (+/_) - Acres <br />6185E (10/90) <br />