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DEPARTMENT OF NATURAL RESOURCES ~ ~) g~ <br />D3viC M. Getchee. Executive Director <br />MINED LAND RECLAMATION DIVISION <br />DAVID C. SNELTON, Dlr~ctor <br />RicnarE D. Lamm <br />Governor APPLICATION FORM FOR A REVISION <br />TO A COAL MINING AND RECLAMATION PERMIT <br />This form must be completed and submitted with all requests for minor revisions. as <br />defined to Rule 1.04(73), technical revisions as defined in Rule 1.04(36) and permit <br />revisions, as defined 1n Rule 1.04(90). A11 revisions are to address the requirements <br />of Rul a 2,08.4. <br />All revisions are to be formatted so they can be inserted Into the permit to replace the <br />revtsed sections, mops, tables and/or figures. Explain in the revision what section is <br />being revised. The revision date should be printed 1n the tower right corner of the <br />revision pages. If necessary, the Table of Contents should also be revised. <br />Date: 1 2/ 0 9/ 8 8 <br />Permittee: -gy~~-~~li_.IiQ~.-_-- <br />~~.~~-~OM PINY --- ~1fr'~~~,ti;,~; .~ <br />Street: ~~~-1i.s2817~~~-.~ T - -. _~ <br />S U I T E_ 2 0 5 CEC 12 ,o~~ <br />City: G R A N D J U N C T I O N--!~F~"~r'~'-''r :f <br />State: C _0 Zip Code: 8 1 5 0 6 - - _ - - ~Llt Jt~t>°t•v~ <br />Permit No.: C -~8 1- 0 4 7 r <br />This box to be filled in by the Division: <br />Type of Revision: '` ~ (PR, TR, or MR) <br />Revision Nlmber p ~ (Sequential by Revision Type) <br />Revision Submittal Date i? /L/ 8~(Date Received by Division) <br />Revision Completeness Date Iz/la/s 8 Revision Incompleteness Date -/ / <br />Revision Adequacy Due Date / - Revision Adequacy Date -/-/- <br />Revision Decision Due Da e 2 /~3/ irfl Fee E0.00 <br />Brief Description of Revision: ~ ~ ~ .4.. ~ ~ -T R U C x - - _, <br />S C A L E_ A_ R E A_ F R 0 M P E R M I T <br />Public Notice Attached - Yes ~_ No _(Required for PR's and TR's) <br />Bond Increase: Yes r No ~ <br />Proposed Change in: <br />Disturbed Area (+/_} - - - - Acres Affected Area (+/-) - - - - Acres <br />Permit Area (+/-) - _ 0 . 8 Acres Federal Land (+/-) _ - - Acres <br />State Land (+/-) Acres Private Land (+/-) - 0.8 Acres <br />Lead Reclamation Specialist ~ ~ ~ 6185E <br />423 Centennial Building, 1313 Sherman Street Denver, Colorado 80203 Tel. (303) 866-3567 <br />iiiiiiiiiiiniiiiii <br />999 <br />