REV100789

• Permit No: C1981013
• IBM Index Class Name: Revision
• Doc Date: 2/13/1995
• Doc Name: APPLICATION FORM FOR A REVISION TO A COAL MINING AND RECLAMATION PERMIT
• Type & Sequence: MR65
• Media Type: D
• Archive: No

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DIV1510N OF MINERALS MID GEOLOGY . «•
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F~x:fioslas2atfw APPLICATION FORM FOR A REVISION
TO A COAL MINING AND RECLAMATION PERMfT
DIVIS10f1 of fvunatala a vc~W9Y
This form must be completed and submitted with all requests for minor revisions, as defined in
Rule 1.04(73), technical revisions, as defined in Rule 1.04(361, and perms revisions, as defined
in Rule 1.04(901. All revisions are to address the requirements of Rule 2.08.4. Three 13) copies
of the revision, indudinp maps, must be submitted in order for it to be complete.
Roy Romer
Go.~nnor
E,ttutbe D~.tte
MIC~Y~ B. LOIM.
D~.s~ai Oireao,
All revisions are to be formatted so they can be inserted into the permit to replace tfte revised
sections, maps, tables andlor figures, with a revised Uble of contents, if necessary. The revision
submittal date should be printed in the lower right corner of each revision page. A cover letter to the
revision should explain the nature of the revision and reference the specific permit settions being revised.
For federal mines, a copy of the revision application must be submitted to ell agenaea on the federal mailing
list at the same time the application is submitted to the Division, and proof of distribution must be submitted
to the Division along with the application. Copies of revision pages modified during the review process must
be distributed in the same manner, along with proof of distribution. Proof of distribution must be submitted
prior to implementation of the revision. For non-federal mines, a copy of the application for which the
Division has issued a proposed approval decision must be submitted to the OSM Albuquerque Field Office
(AFOI, and proof of submittal to AFO must be submhted to the Division prior to implementation of the
revision.
Permit No,: C - ~ 2 - D ( 3 Date: _ ~ l 1 L' l ~/ S/
Permittee: ~ A 5 ~~- /Z~ SU cJ 2 ~e S - - - -
_G D ~G 7J ~ N - ~' ~ 6 L ~ 1'i~~c-%~
street: ~ ~ 3 U Q -/~l 6 /,~C~rF ~% / L -
City: ~~ S ~ U2~ - -~- - - - - - -
State: ~~ U Zip Code; ~l ~'~ / -- - - -
Brief Description of Revision: 3' ~ ~~~'~•~ 'I? <~= ~~~ ~~'~ - - - - -
Public Notice Attached: Yes - No ,~ (Required for PRs and TRsJ
Bond Increase: Yes No - Federal ~ Non-Federal - Mine
Proposed Change in:
Disturbed Area (+/-) - - - -Acres
Perrttit Area (+/-) - - - . -Acres
State Land (+/-) - - - . -Acres
Affected Area (+/-) - - - . -Acres
Federal Land (+/-) _ - - . -Acres
Private Larfd (+!-) - - - -Acres
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