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` AUG 2 2 139 r <br />r <br />D1vI5i0n 01 Minera~~ ...:.~,,:,,,,; <br />DIVISION OF MINERALS AND GEOLOGY <br />DChrrimenl nl Nalurdl Reunuces <br />STATE OF COLORADO <br />1 313 Shcrnlun 51.. Ruonl ! 1 i <br />Denver, Coloradu 80!07 <br />Phone: IN131 A66J 567 <br />FAxl3ona3z-Alo6 AppLICATION FORM FOR A REVISION <br /> <br />TO A COAL MINING AND RECLAMATION PERMIT <br />_:. <br />I~~I~ 1 <br />DEPARTMENT OF <br />NATURAL <br />RESOURCES <br />This form must be completed and submitted with all requests for minor revisions, as defined in R,ly Romer <br />Rule 1.041731, technical revisions, as defined in Rule 1.0411361, and permit revisions, as defined ~OVef""' <br />in Rule 1.041901. All revisions are to address the requirements of Rule 2.08.4. Three 13) copies `•'~~k•~sV i~nn,;;~~ <br />of the revision, including maps, must be submitted in order for it to be complete. <br /> AII, Il.ll'~ 11 11)ill <br /> 1 li,~~~j~l~l ~)III'1 I1 ~I <br />All revisions are to be formatted so they can be inserted into the permit to replace the revised <br />sections, maps, tables and/or figures, with a revised table of consents, if necessary. The revision submittal <br />date should be printed in the lower right corner of each revision page. A cover letter to the revisi on should <br />explain the nature of the revision and reference the specific permit sections being revised. <br />For federal mines, a copy of the revision application must be submitted to all agencies on the federal mailing <br />list at the same time the application is submitted to the Division, and proof of distribution must be submitted <br />to the Division along with the application. Copies of revision pages modified during the review process must <br />be distributed in the same manner, along with proof of distribution. Proof of distribution must be submitted <br />prior to implementation of the revision. For non-federal mines, a copy of the application for which the <br />Division has issued a proposed approval decision must be submitted to the OSM Western Regional <br />Coordinating Center (1999 Broadway Blvd., Suite 3320, Denver, CO 80202-5733), and proof of submittal <br />to OSM must be submitted to the Division prior to implementation of the revision. <br />Permit No.: ~ - 4 ~ - Q $ 3 Date: Q $ /~ 9J 4 Z <br />Permitlee: H4~lIE_BES4IIB~EB_LIMITEII____ <br />H 4 'd I E _ N 4 ~ _ ~ _ M I H E _ _ _ _ _ _ _ _ _ _ _ <br />Street: E~II.~_BQX_9$~.________________ <br />- - - - - <br />City: P B Q H I - - - <br />B - - - - - - <br />- - - - - - - - - - - <br />- - - - - - - - - - - - - - - - <br />- - - - - - - - <br />State: Q4 ZipCode:$1 42 E.- __ ________ ____ <br />Brief Description of Revision: H L B H T_ H Q T I E I~ 8 T 14 H ,& __ <br /> >y 4 Y _ C Y _ 4 Z = Q 1 3 _ _ _ _ _ _ _ _ <br /> B E B T E M E)y T _ _ _ _ _ _ _ _ _ _ _ _ <br />Public Notice Attached: Yes _ xo XX (Required /or P/Is and T/Is / <br />Bond Increase: Yes _ xo %X Federal XX Non-Federal _ Mine <br />Proposed Change in: <br />Disturbed Area (+/-) _ _ Q,Q Acres Affected Area (+/-) _ _ Q.Q Acres <br />Permit Area (+/-) _ _ Q.Q Acres Federal land (+/-) _ _ Q.Q Acres <br />State land (+/-) _ _ q,g_ Acres Private land (+/-) _ _ Q,g, Acres <br />