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o_' CO~o _ 69 4~' 7 g COLORADO D~VISION OF MINERALS AND GEOLO ~•~• 1313 Sherman S[re ,Room 215, Denver, Colorado 80203, (303) 866-356' III IIIIIIIIIIIII III ~a~c • APPLICATION FORM FOR A REVISION TO A COAL MINING AND RECLAMATION PERMIT OCI L 3 1997 flivisini~ „~ ~.~ ~~mam u ~eauny This form must be completed and submitted with all requests for minor revisions, as defined in Rule 1.04173), technical revisions, as defined in Rule 1.0411361, and permit revisions, as defined in Rule 1.04(90). All revisions are to address the requirements of Rule 2.08.4. Three 131 copies of the revision, including maps, must be submitted in order for it to be complete. All revisions are to be formatted so they can be inserted into the permit to replace the revised sections, maps, tables and/or figures, with a revised table 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 sections being revised. For federal mines, a copy of the revision application must be submitted to all agencies on the federal mailing list lexcept OSM) 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. Permit No.: C - g0 - 006 Date: 1n ! 17 / 9L Permittee: KERR COAL COMPANY POST OFFICE BOX 487 Street: 1130 COUNTY ROAD 29A City: WALDEN State: ~_ Zip Code: Rn480 - Brief Description of Revision: CHANGES IN TIPPLE RECLAMATION PLAN Public Notice Attached: Yes ~' No Bond Increase: Yes _ No ~ Proposed Change in: (Required for PRs and TRsI Federal _ Non-Federal ~ Mine Disturbed Area Q+/-) _ _ 2 . ri Acres Permit Area a-) _ _ 2 5 Acres State Land 1 +!-) _ _ _ _ Acres Affected Area ~'-) _ _ 2 . ~ Acres Federal Land (+1-) _ _ _ _ Acres Private Land ~-) _ _ ~ . 5 Acres