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;8-1997 06:09 GRRND VRLLEY CORL C0 303 858 7690 P.02 <br />III IIIIIIIIIIIII III <br />STATE OF COLUi~v~ <br />VISION OF MINERALS AND GEOLOGY <br />9eparanenl of Natural Rewur[es ~~~~~ <br />'1)17 $herrnan Sl., Room 21 5 <br />prover. Colorado 60203 <br />Phone:Ilol~ a66.35fi7 <br />FA%: 13071832-8106 AppLICATION FORM FOR A REVISION <br />TO A COAL MINING AND RECLAMATION PERMIT N ~IiL <br />RESOURCES <br />This form must be completed end submitted with e11 requests for minor revisions, as defined in Ro>, Rune. <br />Rule 1.04173), technical revisions, as defined in Rule 1,0411361, and permit revisions, as defined cO""n0' <br />in Rule 1.04190). All revisions are to atldress the requirements of Rule 2.08.4. Three (31 copies F n+e, s.2 o h~e <br />of the revision, including maps, must be submitted in order for it to be complete. <br />Michael B. Long <br />l)i~isbn Oin!cro• <br />All revisions are to he 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 contents, if necessary. The revision submittal <br />date should be printed iri the lower right corner of each revision page. A cover letter to the revision should <br />explain the nature of the revision and reference the spedfic 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 />tc the DiWSion along with the application. Copies of revision pages modified during the review process must <br />he distributed in the same manner, along wkh 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 derision must be submitted to the OSM Western Regional <br />Coordinating Center f i 999 F3roadway Btvd., Suite 3320, Denver, CO 80202-5733), and proof of submittal <br />to OSM must ba submitted to the Division prior to implementation of the revision. <br />Permit No.: C - ~ ~ - Q 6 ~ Date: ~i , 2 / L ~- l ~ Z <br />Permittee: C72..:l~~1 ~-~c~L~~L~--- <br />~.~~-._ CQ~-.-- /---- <br />Street: ~~-~~~-~ b-_---- <br />City: ~~: ~ ~ - - - - - - - - - - - <br />State: ~. Q Zip Code: ~ _[_ ~~ ~ ~ - Ot~ <br />Brief Description of Revision: ~Q ~ (~ ~,.g ~~ ~ ~~ <br />Public Notice Attached: Yes - No ~ (Required for PRs and TRs) <br />Bond Increase: Yes -,; No ~ Federal ~ Non-Federal - Mine <br />Proposed Chengein: <br /> <br />Disturbed Arse (+/-) - _, <br />Permit Area (+!-) - - Q <br />State Land (+ /-) - - <br />m :lco aRsFlare\f orms166a5 <br />Acres Affected Area 1+/-1 - -~ <br />Acres Federal Land 1 +!-1 - - SL <br />Acres Private Land (+/-) ~ - <br />-Acres <br />-Acres <br />-Acres <br />