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STATE OF COLORADO <br />MINED LAND RECLAMATION DIVISION <br />Department of Natural Resources <br />1313 Sherman SI.. Room 275 <br />Denver. CO 80203 <br />303 866-3567 <br />Fax: 303 6326106 <br />F COyO <br />.l~ ~'vy0 <br />~~ ~ 1 <br />.,~8 J. <br />Ray Romar, <br />Gavemor <br />Frad R. Barra. <br />APPLICATION FORfd FOR A REVISION Div~slon Olrector <br />TO A COAL MINING AND RECLAMATION PERMIT <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 mist 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 - ,$ Q - ~Q~- <br />Date: -12 / 12 / ~1- <br />Permittee: Mountgi~„ Ss41 G.Qmpsl(~(- - - - - ~~ <br />Street: P.Q. Box 591 - - -, - -. - - - - pEC 1 6 1991 <br />city: _Somerset - _ -_ -_ -_ - - - - Nlined Land <br />- - - -'P~^1amaUon ~~r~^' <br />State: ~Q Zip Codei ~~~ - - - ~r~ - - <br />Mine Name: ~Ie~t.~1k.N1tn~.-----------. -. <br />Brief Description of Revision: C0o1 refllS~, ~(1~0,4.1 ~..t4rage~ad. - - - <br />fill. <br /> <br />Public Notice <br />Attached <br />-Yes - <br />_~ ------ <br />No i (Required ----- <br />for PR's and ---- <br />TR's) <br />Bond Increase: Yes ~ No ~_ Federal ~ Non-Federal Mine <br />Proposed Change in: <br />Disturbed Area (+/-) <br />Permit Area (+/-) <br />State Land (+/-) <br />- - ~.- Acres <br />- - ~.- Acres <br />- - ~ Acres <br />Affected Area <br />Federal Land <br />Private Land <br />(+/=) - - ~,- Acres <br />(+/-) - - ~ Acres <br />(+/-) Q Acres <br />6185E (10/90) <br />