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<br /> <br /> <br /> <br />STATE OF <br />RADO <br />DIVISION OF MINERALS AND GEOLOGY rrlJY ~ ` 1JJ5 <br />Dc~unmeni of Natural Rcaoarces <br />Division ~~~~` <br />Dtnvc h Culorrado ~~ 1 ? 15 of Mlneralg a UeU109Y <br />Phnnc. 1 JDJI flhh-J Sh7 <br />r~x uoneJZ eiub APPLICATION FORM FOR A REVISION <br />TO A COAL MINING AND RECLAMATION PERMIT DEPARTMENT OF <br />NATURAL <br />RESOURCES <br />This form must be completed and submitted with all requests for minor revisions, as defined in Ror comer <br />Rule 1.041731, technical revisions, as defined in Rule 1.0411361, and permit revisions, es defined c°"er"°' <br />in Rule 1.04(901. All revisions are to address the requirements of Rule 2.08.4. Three 131 copies E;mn s~DnhMeod <br />of the revision, including maps, must be submitted in order for it to be complete. <br />Michael B long <br />Drvirron Dvecmr <br />All revisions are to be formatted so they can be inserted into the permit to replace the revised <br />sections, maps, tables and/or figures, with a revised table of contents, if necessary. The revision submittal <br />date should be printed in the lower right corner of each revision page. A cover letter to the revision should <br />explain the nature of the revision and reference the specific permit sections being revised. <br />For federal mines, a copy of the revision application must be submitted to ell agencies on the federal mailing <br />list at the same time the application is submitted to the Division, and proof of distribution must be submitted <br />to the Division along with the application. Copies of revision pages modified during the review process must <br />be distributed in the same manner, along with proof of distribution. Proof of distribution must be submitted <br />prior to implementation of the revision. For non-federal mines, a copy of the application for which the <br />Division has issued a proposed approval decision must be submitted to the OSM Western Regional <br />Coordinating Center (1999 Broadway Blvd., Suite 3320, Denver, CO 80202-57331, and proof of submittal <br />to OSM must be submitted to the Division prior to implementation of the revision. <br />Permit No.: C - ~ ~ - © ~ ~ Date: ~ ~ / ~ ~ ! ~ ~ <br />Permittee: ~ l9 N L ~ ~i ~ ~i(~l(~{ ~ W ~r <br />- - - - - - - - - - - - - - - <br />Street: ~ ©_gA~_o~~_______ <br />- - - - - - - - - - - - - - - <br />State: ~~ Zip Code: ~ p~ ~ ,~ ~ - 0 ~. g ~ nn <br />Brief Description of Revision: R~ ~~ Fj~J~ ~C.1~'T(OA)_IvL~}/J <br />-~NQ'----------- <br />Public Notice Attached: Yes _ No ~ /Required for PRs and TRs/ <br />Bond Increase: Yes _ No ~ Federal ~, Non-Federal _ Mine <br />• Proposed Change in: <br />Disturbed Area (+/- <br />Permit Area (+ /- <br />State Land 1+/- <br />m:\co allshere\tormc\8665 <br />1_ . P <br />1__Q <br />1_ <br />Acres Affected Area (+/-) <br />Acres Federal Land (+/-) <br />_ Acres Private Lend 1+/-) _ <br />_ Acres <br />Acres <br />Acres <br />