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::-~x . COLORADO DIVISION OF RECLAMATION, MINING AND SAFETY c <br />`: ~`"~' 1313 Sherman Street, Room 215, Denver, Colorado 80203, (303) 866-351(~~/~'R~}(`~~u~~ ~~C~ <br />8I6~ • _` <br />x _ ._ <br />~ APR ~5 2,401 <br />Division of Reclamation, <br />APPLICATION FORM FOR A REVISION Divistdiniiig and Satety ' <br />TO A COAL MINING AND RECLAMATION PERMIT Minuiy -• •- ~~ -~+' <br />Th~ form must be cmnpleted and submitted with all requests for minor revisions, as defined in Rule 1.04(73), <br />technical revisions, as defined in Rule 1.04(136), and permit revisions, as defined in Rule 1.04(90). All revisions <br />are to address the requirements of Rule 2.08.4. Three (3) copies of the revision, including maps, must be <br />submitted in order for it to be complete. <br />All revisions are to be formatted so they can be inserted into the permit to replace the revised sections, maps. <br />tables andlor figures, with a revised table of contents, iF necessary. The revision submittal date should be printed <br />in the bwer right comer of each revision page. A cover letter to the revision should explain the nature of the <br />revision and reference the spedfic permit sections being revised. <br />For federal mines, a copy of the revision application must he submitted to aU agerraes on the federal mailing list <br />(except OSM) at the same time the applicetion is submitted th the Divsion, and proof of distn'butiort must be <br />submitted to the Division along with the appfx~6on. Copies of revises pages modifred during the review process <br />mint be dislnbuted in the same manner, abng with proof of distribution. Proof of distribution must be submitted <br />prior lb rmplernentatiorr of the revision. <br />Permit No.: C - 96 - D 8y Date: y l-~ l D ~ <br />Pennittee: l,o ~ Gnct ~ COG--~ ~ mp9~ti <br />y//~~ /~ . ,, <br />.citreet: / 7 z Z Bry an ~u.T tM ~ O ~` <br />city: ,hex r~ <br />State: ~~ Zip Code: OS 6 <br />Brief Description of Revision: ~2tJ l S~- ~e~l0.ynW/ lev, awt~ <br />1,c,oQr^o~o9tc~ yy/,enrlvPiN~/ A~°U2S <br />~_.~_ <br />Public Notice Attached: Yes ~ No -' (Required for PRs and TRs) <br />Bond Increase: Yes - No ~ Federal - Non-Federal ~ Mine <br />Proposed Change in: <br />Permit Area - <br />Disturbed (+/-) - - 0 . ~ Acres <br />Permit (+/-) - _ U . U Acres <br />Affected (+/-) - - O . ° Acres <br />Mineral Ownership - <br />Mineral Private (+/-) - , - . ,Aces <br />Mineral Federal (+/-) - ~ - . -Acres <br />Surface Ownership - <br />Private Land (+/--) - - - . -Acres <br />Federal Land (+/-) - - - . -Acres <br />State Land (+/-) _ - - - -Acres <br />Mineral Slate (+/-) - ,_ _ . -Acres <br />