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<br />STATE OF COLORADO <br />MINED LAND RECLAMATION DIVISION <br />Department of Natural Resources <br />t3t3 Sfterman St.. Roam 215 <br />Denver. C080203 <br />303 866-3567 <br />RA X: 303 832-8106 <br />pF Cp~ <br />~4. 9 <br />s <br />~'~~W' ,y'~" O• <br />~ re76 ~ <br />Ray Ramer, <br />GavemOr <br />' Rrgd R. Banta. <br />APPLICATION FORM FOR A REVISION Dinsion D~ractor <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 far <br />non-Federal mines 1 copy mist be sent to OSM at 625 Silver Avenue, $W, 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- B z- 0 5 6 <br />Date: -~ o/ i t/ 9 i ®~ C ~~ V F <br />Permittee: T W ELI LY~,1 Lam- C O A L 6'~ r <br />- ---- 0CT16 1991 <br />Street: z 9 5 t s-~Q~SS---- <br />c o u N T ~.-g,Q~~-Z,i,- Mined Land <br />Reclamation Division <br />City: O A K - Cgs-E~----------_, <br />State: C O. Zip Code: $ ~ y- ~ L - - - - - <br />Mine Name: F O I D E S-~$~~~,-~L,pL~_,-- <br />Brief Description of Revision: _T I P_P L E - 2 -D I ~ S~ J, _, - - - <br />T A N K <br /> <br />Public Notice <br />Attached - - <br />Yes ----------,- <br />No X (Required for PR's and .-.--.- <br />TR's) <br />Bond Increase: Yes No X Federal X Non-Federa] Mine <br />Proposed Change irt: <br />Disturbed Area (+/_) _ N!A_._ Acres <br />Permit A.-ea (+/_) _ N/A_._ Acres <br />State Land (+/-) N/A Acres <br />Affected Area (+/_) N/A _ Acres <br />Federal Land (+/-) N/A Acres <br />Private Land (+/_) -~_ Acres <br />