2005-10-05_GENERAL DOCUMENTS - C1989074

• Permit No: C1989074
• IBM Index Class Name: General Documents
• Doc Date: 10/5/2005
• Doc Name: AVS File
• Media Type: D
• Archive: No

REQUEST FOR AVS COMPLIANCE CHECKS
Permit No: C- Application Type & #:
Applicant: TIM ??? (?%?1? ( MSHA Id No.: /
=ck: y 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: q I /a Date OSM:
AVS Evaluation: L,s{- 3 Vibla-HL
OSM Evaluation:
DMG Recommendation: EK)W
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:
3rd Check: Issuance of application (3-5 days prior)
Date AVS:
AVS Evaluation:
OSM Evaluation:
DMG Recommendation:
Final Check: After Issue/Decision timeframes dre over
Date of Issue/Decision:
Permit Expiration: _
Permitted Acres:
Date OSM:
***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.
Date OSM:
MAcoal\sNre\formsUtequest for AVS Compliance Checks.doc