2007-11-16_GENERAL DOCUMENTS - C1984063

• Permit No: C1984063
• IBM Index Class Name: General Documents
• Doc Date: 11/16/2007
• Doc Name: AVS File
• Media Type: D
• Archive: No

REQUEST FOR AVS COMPLIANCE CHECKS
Permit No:
Applicant:
lst Check:
G45;de COW Co.
Application Type &
MSHA Id No.:
Adequacy of application (within 30 days of completeness)
Attach a current list of the owners and controllers for the applicant and the operators, as required
by Rule 2.03.4, Identification of Interests. If applicable, a list of permits held by the applicant in
other states, by numbers and state codes.
Date AVS: 1? Date OSM: ?5 0
AVS Evaluation: ?(3 V, b 10-t-1 &ns
OSM Evaluation: 4
DMG Recommendation: 'Y Su e-
Note: Once you get the new information back from the operator on any AVS questions or concerns,
please give to AVS person to make sure the concerns have been fixed and AVS can be updated.
2nd Check: Proposed Decision of application. (3-5 days prior)
Date AVS:
AVS Evaluation: _
OSM Evaluation: _
DMG Recommendation:
3`d Check: Issuance of application (3-5 days prior)
Date AVS:
AVS Evaluation:
OSM Evaluation:
Date OSM:
Date OSM:
DMG Recommendation:
Final Check: After Issue/Decision timeframes are over
Date of Issue/Decision:
Permit Expiration: _
Permitted Acres:
***AVS checks are required for new permit, permit revision, permit renewal, and permit transfer/succession of
operator. AVS checks are also for SOAP applications and state contracts.
MAcoa1\share\forms\Request for AVS Compliance Checks.doc