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i STATE OF COLORADO OtVI510N OF MINERALS AND GEOLOGY Depanmem o! Natural Rewurces 1317 Sherman 51.. Room 215 I`y~~ Denver, ColoraAo 80207 II Phone: 170718667567 FAX: uoll e72~era APPLICATION FORM FOR A REVISION TO A COAL MINING AND RECLAMATION PERMIT DEPARTMEIJi' OF NATURAL RESOURCE This form must be completed and submitted with all requests for minor revisions, as defined in Re7 aa,K, Rule 1.041731, technical revisions, as defined in Rule 1.041361, and permit revisions, as defined ~n~ in Rute 1.04190). All revisions are to address the requirements of Rule 2.08.4. Three 131 copies N"~ 5. Lanheaa of the revision, including maps, must be submitted in order for it to be complete. t.H,nhe onenn M¢hael 8. Long All revisions are to be formatted so they can be inserted into the permit to replace the revised Drvnion O~recra 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 at the same time the application is submitted to the Division, and proof of distribution must be submitted to the Division alon0 with the application. Copies of revision gapes 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 IAFOI, and proof of submittal to AFO must be submitted to the Division prior to implementation of the revision. RECEIVED Permit No.: C - 8 2 - 0 ~ 5 6 Date: t ~ / ~ ~ / _g ~ ~CT 05 Permittee: _7wentymilP Coal Lnmpatly- - - - - - - - - - - - - - - - - - - - - - -division of Minerals a uruwgy Street: ?9515 Routt Count Road H27- - - - - - - - - - - - - - - - - - - - - - City: Oak Creek - - - - - - - - - - - - - - - State: ~p - Zip Code: 80467 - - - - - - - - Brief Description of Revision: TEMPORARY WATER LINE FROM POND D TO LOCATION 3.---------- - - - - - - - - - - - - - - Public Notice Attached: Yes - No X (Required for PRs and TRsI Bond Increase: Yes - No _X Federal X Non-Federal - Mine Proposed Change in: Disturbed Area (+/-) - - 0 0 Acres Permit Area (+/-) - - 0 0 Acres Affected Area (+/-) - - 0 . 0 Acres Federal Land (+/-) - - 0 , 0 Acres State Land (+/-) - - 0. 0 Acres m:\coel\ch erelfo nn a\6895 Private Land (+/-) - - 0 , 0 Acres