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r, r <br />M ~: <br />STATE OF COLORADO <br />MINED LAND RECLAMATION DIVISION <br />Department of Natural Resources <br />t 3t 7 Sherman St., Room 215 <br />Denver. CO 80203 <br />303 866-3567 <br />Fn X: 303 832-Bt06 <br />This farm 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. firee (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 />Roy Romer, <br />Gaveoar <br />Free R. eama. <br />APPLICATION FORM FOR A REVISION Division D~reCtcr <br />TO A COAL MINING AND RECLAMATION PERMIT <br />pF p0 <br />l~'~41 <br />M~~~s. ~8 <br />.:~8 . <br />/BT6 <br />Permit No.: C - g , - ~ L ~ <br />Date: _ / _/ _ _ <br />Permittee: C O L Q~ g~ ~_ Y A M? g- RECENED <br />C O A L_ C O M P A N Y___ <br />Street: 2 9 5 7 9_ R O U T r____ SUN 151993 <br />C O U N T Y ~, R O A D_ 2 7_ <br />C i ty: O A K_ C R E E K ____ -Division of Minerals to Ueaia9Y <br />State: C O Zip Code: 8 o u s ~- __,_ <br />Mine Name: M INES 11 2,_ E _ E C K M A N _ ~g 3i K._ _ _, <br />Brief Description of Revision: C L A R I F I C A T 1 4~_ Q,~ <br /> D E M O N S T R A T~,(~ jy„___, <br />Public Notice Attached -Yes No X (Required for PR's and TR's) <br />Bond Increase: Yes No X Federal _~ Non-Federal Mine <br />Proposed Change in: <br />Disturbed Area (+/-) <br />Permit A^ea (+/-) <br />State Land (+/-) <br />N/A ,_ Acres <br />N/A ,i Acres <br />N/A Acres <br />Affected Area (+/-) _ N/A Acres <br />Federal Land (+/-) _ ~~ Acres <br />Private Land (+/-) N/A Acres <br />