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<br />DIVISION Of MINERAIf AND GEOLOGY ~ <br />pap~ronan of wnRa1 aa.oaee <br />1St 1 fdwnw~ SL. Ileum it s <br />pan.er, Colorado x0101 . <br />Mgne:IlOll aeb1S61 <br />r~ul: aos+us.a+a APPLICATION FORM FOR A REVISION <br />TO A COAL MINING AND RECLAMATION P6iMff <br />This forth must bs Completed and submitted vrhh aU roqueste for minor rovlsiona, as defined In <br />Rule t .04173), technical roviaions, as defined In Rule 1.0411381. and permit revisions, n defined <br />In Ruls 1.04(901. AU rovisions ors t0 address the requlromams of pule 2.08.4. ThrN Iii eopla <br />of the revision, including mspa, must be submitted M order for K to bs Complete. <br />ra-aT. <br />Gore <br />txo. oUaeer <br />wdw+s.tmr <br />_• •-~„-• <br />An revisions are to oe rormattea m they can De mtartea urto trta permit to replace the renseo <br />teetlons, maps, tsblee and/or figures, vvlth a nvisad taDte of eomenq, M necaasary. TM ravGbn <br />submittal date should be printed In the tower right oomar of eadl revision page. A cover latter to the <br />raviaion should explain the nature of the rovislon and ceteret-ee the apsdfle permit aeotbns being revised. <br />For federal mines, a copy of the rovision appUCatbn moat ba submitted to aU apendoa On the federol ma,T,np <br />list at the lama time the applieatlon is submitted to t!a DlWalon, and proof of disaibudon must be submitted <br />to the Division along with the appLeation. Copies of rovisian gapes mod'died during the revkw process must <br />bs distributed In the same msnner, aionp whh proof of dlcVibudar. Proof of diauibudon must bs submitted <br />prior to implamenUtion of 1hs revlslorr. For non-fadsnl.mhros, a copy of the appUcatJon for wrich tie <br />Division has Issued a Dropossd approval decision moat be submitted t0 the OSM AUSUpueraua Field Office <br />1AF01, and proof of submittal to AFO must bs submitted m the bivislon prior to implanentstlon of the <br />rovision. <br />Pemdt No.: C - ~ p,_ - ~ ~, ~ Date: „_ 9 ! ? z / 9 s <br />Permittee: xerr coal co~~ - - - -• - - <br />--~- <br />street: P. SL. l~sx 3~~- - - - , - . - - - - RECEIVED <br />-_------,,_-,--- SEP 151995 <br />a~; Walden- - - _. _.._ - . - - - - - <br />plvision of Mme~als & Geology <br />Stets: C O Zip Code: 80480 r - - - -_ - - <br />Brief Descripdon of Revision: Revision and u~ate of officer _and addresses_ <br />Public Notice Attecherk Yes - No x /Required for PRs and TRs) <br />Bond Increase: Yes - No x Federal _ Nonfederal - Mans <br />Proposed Change in: <br />Disturbed Area (+/-1- _ o o Acres ANeeted Area (+!-1 ._ - ~ . ~ Acres <br />Permit Area 1+/-) _ -r 0 0 Acres Fedsnd Land 1+/-) - - 0 . ~ Acres <br />State Land (+/-1 - - ~ ~ ACre9 Private Land t+/-) - ~, 0 . ~ Acres <br />m:too.nanr.trurtn.t9 a es <br />