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STATE OF COLORADO <br />MINED LAND RECLAMATION DIVISION of ~o~ <br />Department of Natural Resource9 ,~~ <br />e <br />1313 Sherman St.. Room 215 ~ ~ ~ ~~l$ <br />Oenver. CO 80203 <br />303 666.3567 ~ ' <br />Fax: 303 832-8106 `re is ` <br />Roy Ranier. <br />Gwamor <br />FreC R. Banta. <br />APPLICATION FORM FOR A REVISION oi~islan oirea,or <br />TO A COAL MI NI N6 AND RECLAMATION PERMIT <br />This form must be completed and submitted with all requests for minor <br />revisions, as defined in Rule 1.04(73), technical revisions as defined in <br />Rule 1.04(36) and permit revisions, as defined in Rule 1.04(90). All <br />revisions are to address the requirements of Rule 2.08.4. Three (3) copies of <br />your revision including maps must be submitted in order for it to be complete. <br />All revisions are to be formatted so they can be inserted into the permit to <br />replace the revised sections, maps, tables and/or figures. Explain in the <br />revision what section is being revised. The revision date should be printed <br />in the lower right corner of the revision pages. If necessary, the Table of <br />Contents should also be revised. When the final version of the revision is <br />approved, 7 copies must be sent to OSM in Denver far Federal mines and for <br />non-Federal mines 1 copy must be sent to OSM at 625 Silver Avenue, SW, Suite <br />310, Albuquerque, New Mexico 87102. The revision may not proceed until OSM <br />has been provided copies. Copies should be sent certified mail. <br />Permit No.: C - ~ L - ~ ~ ~ `~ f I f .` <br />Date: ~ Lr!/ L$/~. ~ RE~~ c ~0 <br />Permittee: ~ J ~ ~ ~ ~~ - ~ ~ ~ ~ <br />~LZ~L ~ g..~11.~~---- OGT191992 <br />Street: ~ ~ ~ - ~ - ~ £ ~ ~ Q ,(J- - _ Div t5~~~~ ~' <br />MIPdERALS ~ ~~'~`~'"~ <br />City: Ct~ ~~~]L.~~l.~r ---------- <br />State: ~ ,(/ Zip Code: ~ ? Z 1 ~ _ ! - - <br />MineName: ~.~~:~-~.~_QJ~-~ Z-__-- _- <br />8rief Description of Revision: ~ ~ ~ ~ _ ~ - _ ~ ~ .~. _~~ - - - <br />Public Notice Attached -Yes No (Required for PR's and TR's) <br />Bond Increase: Yes No ~ Federal ~ Non-Federal Mine <br />Proposed Change in: <br />Disturbed Area (+/_) ~ ~~,- Acres <br />Permit Area (+/-) _ _ _ _ Acres <br />State Land (+/_) Acres <br />Affected Area (+/_) - - - - Acres <br />Federal Land (+/_) Acres <br />Private Land (+/_) <br />Acres <br />6185E (10/90) <br />