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5 '~ i STATE OF COLORADO DIVISION OF MINERALS AND GEOLOGY Depanment of Natural Resources R~('s I~~~~ 1317 Sherman 51., Room 215 N~ F~VEp Denver, Colorado 8020] Phone: (1071866.3567 APPLICATION FORM FOR A REVISION ~ ~ 1995 FAX: (3011 B12-8106 TO A COAL MINING AND RECLAMATIONIb'r DEPAR3MFN'TOF Minerals & Geology RESOURCES This form must be completed and submitted with all requests for minor revisions, as defined in Roy Ramer Rule 1.04(73), technical revisions, as defined in Rule 1.04(136), and permit revisions, as defined Governor in Rule 1.04190). Afl revisions are to address the requirements of Rule 2.08.4. Three (3) copies lames S. lochhead of the revision, including maps, must be submitted in order for it to be complete. lsecalive Director Michael B. Long All revisions are to be formatted so they can be inserted into the permit to replace the revised Division Direnor sections, maps, tables and/or figures, with a revised table of contents, if necessary. The revision submittal date should be printed in the lower right corner of each revision page. A cover letter to the revision should explain the nature of the revision and reference the specific permit sections being revised. For federal mines, a copy of the revision application must be submitted to all agencies on the federal mailing list at the same time the application is submitted to the Division, and proof of distribution must be submitted to the Division along with the application. Copies of revision pages modified during the review process must be distributed in the same manner, along with proof of distribution. Proof of distribution must be submitted prior to implementation of the revision. For non-federal mines, a copy of the application for which the Division has issued a proposed approval decision must be submitted to the OSM Albuquerque Field Office (AFO-, and proof of submittal to AFO must be submitted to the Division prior to implementation of the revision. ' Permit No.: C- 8 1- 0 1 4 Date: 1 0/ 2 7/ 9 5 Permitter: ~rtergk-FuPJ "Q~ „~t7~. - - - - - ~ - ~DUthfie ltL Mi-rt~ - - - Street: 1190 Count Road 92 - - - - - - - - P. 0. Box 459 City: ~l.o.zetl~---=-------- State: ~O_ Zip Code: ,1226 - - --_ - - - Brief Description of Revision: MR-27_Perltlit Section 2.03 Update - - Public Notice Attached: Yes - No ~ /Required for PRs and TRs) Bond Increase: Yes - No X Federal _ Non-Federal g Mine Proposed Change in: Disturbed Area (+/-) - - JL • 0-Acres Permit Area (+/-) - _ Q . IL Acres State Land (+/-) - - Q . ~ Acres m:lcoel\shere\f orms1886 5 Affected Area (+/-) - _ ~ . ~ Acres Federal Land (+!-1 - - ~ • 0-Acres Private Land (+/-) - - ~ . 0- Acres