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STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY - - <br />Depanmeni of Natural Resources <br />1313 Sherman SI , Foom : I S IrJ~~ <br />Dcrmcr. Cobradu 8U!03 II <br />Phone: 0031 Hbo~ 3567 <br />FAa: 130.117{32-A106 APPLICATION FORM FOR A PERMIT Rif ~~ .i ly;-1 i <br />DEPARTMLifVT OF <br />CONDUCT COAL MINING IN COLORADO FEQ 1 ~ 19~i) NATURAL <br />RESOURCES <br />Uryi3ion <br />Application to conduct surface or underground coal mining activrties d'~ fif(Keulsul(~ce coal hurHumc. <br />mining and reclamation operations in Colorado pursuant to C.R.S. 34-33-101 et seq. `"""""" <br />inmr.5 Lw hlirad <br />l u•iuiov L)JCINN <br />For an application to be deemed complete by the Division pursuant to C.R.S. ~,,sn,cin war <br />34-33-103(5) and Rule 1.04130), an applicant must: 11) supply all information as u~.,.,~~u,r~rl,., <br />specified on this application form; 12) submit five reproducible copies of the permit <br />application with original signatures; and (3) pay the appropriate tee requred by Rule 2.01.6. For <br />federal mines, please refer to the Federal Agency Mailing List available from the Division and provide <br />one copy to each of the agencies on that list, at the same tune the application is submitted to the <br />Division. Proof of distribution to tl3e federal agencies should accompany tl3e application. Copies <br />of application pages modified during the review process must be distributed in the same manner, <br />along with proof of distribution. <br />Please note that this form is only a listing of general category requirements and does not constitute <br />a checklist of detailed permit application requirements. A finding of completeness should not be <br />interpreted to imply adequacy of an application. AddiUOnal information not listed on this loan may <br />be required for adequacy depending upon the individual circumstances of an application. After a <br />decision has been reached on this application, file operator must update the permit application on <br />file at DMG and OSM. For non-federal mines, one copy must be sent to OSM m Albuquerque. New <br />Mexico. <br />This form consists of two major parts: (1) a section entitled "Application General Operation <br />Information: and (2) a section entitled "Application Requirements." Specific instructions for tilling <br />in the necessary information for each section appears immediately below the title of each <br />section. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly the appropriate information as listed below. Supplernental sheets may be <br />used as necessary; such sheets must be attached to the form and referenced or keyed to the <br />numbers on the form. <br />1. Application Number Ito be filled in by the Division); C - 9 6 0 8 3 <br />2. Permittee: R O <br />L I <br />3. MineiSite Name: f3 <br />~4 <br />W <br />M <br />n <br />M I <br />I >; R r s n u a c r. s <br />- <br />I T E D <br />w i F N o - - z - - <br />N fi - <br />Current Permit Type: C' O <br />