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. ~' <br />OF' COC <br />~~' Q O'py <br />Q -Jt,«;'1~' p <br />o DEPARTMENT OF NATURAL RESOURCES <br />y ~. O y Davitl H. Gelcnes, Executive Dueclor <br />#~~ ' MINED LAND RECLAMATION DI1 <br />a X876 f DAVID C. SHELTON, Director <br />R~cnartl D. Lamm <br />Governor APPLICATION FORM FOR A REVISION <br />TO A COAL MINING AND RECLAMATION PERMIT <br /> <br />This forth must be completed and submitted with all requests for minor revisions, as <br />defined in Rule 1.04(73), technical revisions as defined in P.u1e 1.04(36) and permit <br />revisions, as defined in Rule 1.04(90). All revisions are to address the requirements <br />of Rule 2.08.4. <br />Atl revisions are to be formatted so they can be inserted into the permit to replace the <br />revised sections, maps, tables and/or figures. Explain in the revision what section is <br />being revised. The revision date should be printed in the lower right corner of the <br />revision pages. If necessary, the Table of Contents should also be revised. <br />Date: 0 4 / 2 ~/ ~ Z <br />Permittee: z x ny P P ~~-M 3~~1i_~_ <br />I N C <br />Street: P o _.1i..4_~L_ 1 ~.1._---- <br />City: C R A I G _______________ <br />State: c o Zip Code: ~ ~ ~ 1 ~ - _ <br />Permit No.: C- 8 1- Q I Q <br />This box to be filled in by the Division: <br />Type of Revision: _ _ (PR, TR, or MR) <br />Revision Number _ _ (Sequential by Revision Type) <br />Revision Submittal Date _/_/_ (Date Received by Division) <br />Pevision Completeness Date _/ / Revision Incompleteness Date _/ / <br />Revision Adequacy Due Date _/ / Revision Adequacy Date _/ / <br />Revision Decision Due Date / / Fee 50.00 <br />Brief Description of Revision: x E s u r L D_ r o :.! D~_ _ <br />- <br />Public Notice Attached - Yes - - - <br />x No - - - - - <br />(Required for - - - - - - <br />PR's and TR's) - - <br />Bond Increase: Yes _ No x <br />Proposed Change in: <br />Disturbed Area (+/-) _ _ 0. 0 Acres Affected Area (+/-) _ _ 0._ Acres <br />Permit Area (+/-) _ _ _ Acres Federal Land (+/_) _ _ _ Acres <br />State Land (+/-) _ ` 0 Acres Private Land (+/_) _ _ _ Acres <br />Lead Reclamation Specialist c a S 6185E <br />423 Centennial Building, 1313 Sherman Street Denver, Colorado 80203 Tel. (303) 866-3567 <br />