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STATE OF COLORADO <br />MINED LAND RECLAMATION DIVISION oF.~o~ <br />Department o! Malurai Resources tib~y <br />1913 Sherman St.. Room 215 '~^~~8 Ala <br />Denver, CO 60203 ~ ~~/ <br />303 866.3567 ~. .~ <br />Fax: 903 832.6106 re~a <br />Ror fbnw, <br />Gorarrcr <br />FreA R. Banta. <br />APPLICATION FORM FOR A REVISION oiMSiwt Diran« <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 1s <br />approved, 7 copies must be sent to OSM in Denver for Federal mines and for <br />non-Federal mines ] copy mist be sent to OSM at 625 Silver Avenue, SW, 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 />PermitNo.: C-$3 - O SQ <br />Date: Q Q/2 7/ Q 3 <br />Permittee: TE RR OR_C~E E K_C OMPANY__~______ <br />~FCEIVEC <br />Street: 1 8 4 0 _x~ Gg WB Y_ 1 3 3 ____~P„~~~___ <br />City: P A 0 N I A - - - - - - - - - - - -~-i=,~~_,~~•~ r_~n_•~~_3Le~~3} - <br />State: C 0 Zip Code: 8 1 4 2 8- <br />- - - - - - - - - - - - - - <br />MineName: '~'~R$OR_Q$~F$_~0 Up0 UT________ <br />Brief Description of Revision: $ E V ~ S ~•_ & _ C L ~ $ ~ F Y _ _ <br />P L A N <br />- - - - - - - - - - - - - - - - - - <br />Public Notice Attached - Yes COX No _ (Required for PR's and TR's) <br />Bond increase: Yes XX No _ Federal _ Non-Federal ~ Mine <br />Proposed Change in: <br />Disturbed Area (+/-) _ _ 0.0 Acres Affected Area (+/-) _ _ 0.0 Acres <br />Permit Area (+/-) _ _ 0.0 Acres Federal Land (+/-) _ _ Q.0 Acres <br />State Land (+/-) _ _ Q Acres Private Land (+/-) _ _ 0 Acres <br />6185F (10/90) <br />