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III IIIIIIIIIIIIIIII <br />STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources <br />1313 Sherman 51., Room 215 <br />Denver, Colorado 90707 <br />Phone: U03) 866.7567 <br />FAX: 17071932-9106 APPLICATION FORM FOR A REVISION <br />TO A COAL MINING AND RECLAMATION PERMIT <br />~~~w <br />D£PARTfvI£t~fi' C - <br />NATURA <br />RESOURCF <br />This form must be completed and submitted with all requests for minor revisions, as defined in Roy Romer <br />Rule 1.04(731, technical revisions, as defined in Rule 1.04(36y, and permit revisions, as defined cnvenw. <br />in Rule t .04(901. All revisions are to address the requirements of Rule 2.08.4. Three 131 copies lames 5. Lochhead <br />of the revision, including maps, must be submitted in order for it to be complete. rFeC°""e °1eCOf <br /> Michael B. Long <br /> <br />All revisions are to be formatted so they can be inserted into the permit to replace the revised Division Direcl°r <br />sections, maps, tables and/or figures, with a revised table of contents, if necessary. The revision <br />submittal date should be printed in the lower right corner of each revision page. A cover letter to the <br />revision should 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 Albuquerque Field Office <br />(AF01, and proof of submittal to AFO must be submitted to the Division prior to implementation of the <br />revision. -_~~ / ' ' `" <br />Permit No.: C ~ _~ / - ~ ~ 7 Date: ~ ~ / a s_ / 9 ~~ij~l /L- 0 7 <br />Permittee: ~i4aM-~u,a-E ~'owt~i9M/y - - - _ - <br />--- --------- RECF+(/F~ <br />Street: 1.3~- ~ ~ ~ $T - SK tT~ 3S0 - - a <br />- - ~l 2 81994 <br />~~ / ~ L'ivl$i0n Ot fgi(7FId15 a "e•.v9i <br />City: - ----------- <br />State: C p Zip Code: _ ~ 0~~~ - - - - - <br />Brief Description of Revision: C.(~}~Nd-i~ 1Q~ci9R~ io_~D?~~1'~ ~'~~~~' <br />~o~~Ry- ow N Erq <br />Public Notice Attached: Yes - No~ (Required for PRs and TRsI <br />Bond Increase: Yes - No ~ Federal - Non-Federal ~ Mine <br />Proposed Change in: ~~ <br />Disturbed Area (+/-) - - - -Acres Affected Area (+/-) - - - _ Acres <br />Permit Area (+/-) - - - -Acres Federal Land (+/-) - - - -Acres <br />State Land (+/-) - - <br />-Acres Private Land (+/-)- - - -Acres <br />m:1w allcherelfa trot\88e 5 <br />