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Permit No; <br />Applicant: <br />1St Check: <br />REQUEST FOR AVS COMPLIANCE CHECKS <br /> <br />Y-4 & V-e <br />Application Type & #: <br />MSHA Id No.: <br />l1N-d y <br />Adequacy of application (within 30 days of completeness) <br />Attach a current list of the owners and controllers for the applicant and the operators, as required <br />by Rule 2.03.4, Identification of Interests. If applicable, a list of permits held by the applicant in <br />other states, by numbers and state codes. <br />Date AVS: <br />AVS Evaluation: <br />OSM Evaluation: <br />Date OSM: <br />DMG Recommendation: <br />Note: Once you get the new information back from the operator on any AVS questions or concerns, <br />please give to AVS person to make sure the concerns have been fixed and AVS can be updated. <br />2nd Check: Proposed Decision of application (3-5 days prior) <br />Date AVS: <br />AVS Evaluation: <br />OSM Evaluation: <br />Date OSM: <br />DMG Recommendation: <br />3rd Check: Issuance of application (3-5 days prior) <br />Date AVS: .-I ZCp Date OSM: <br />AVS Evaluation: Sg Ue <br />OSM Evaluation: b CJ <br />DMG Recommendation: <br />Final Check: After Issue/Decision timeframes are over <br />Date of Issue/Decision: <br />Permit Expiration: <br />Permitted Acres: <br />***AVS checks are required for new permit, permit revision, permit renewal, and permit transfer/succession of <br />operator. AVS checks are also for SOAP applications and state contracts. <br />MAcoal\share\forms\Request for AVS Compliance Checks.doc