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REQUEST FOR AVS COMPLIANCE CHECKS <br />Permit No: G ?a - 0 7q Application Type & #: <br />Applicant: TIM YDC-,? C'eaP MSHA Id No.: / <br />1St Check: Adequ y 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: q la Date OSM: <br />AVS Evaluation: Ls? 3 to <br />OSM Evaluation: <br />DMG Recommendation: T)?-o <br />,y <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 />2°a Checksc roposed Decision of application (3-5 days prior) <br />/ I Ste- <br />ate AVS: 1 z D I Date OSM: 2 / 3 I ? I S <br />AVS Evaluation: V o(Ao-K-? God i&tR xvl o'l&h b?v paq e ` <br />OSM Evaluation: Of <br />DMG Recommendation: TES LA e- <br />3?d Check: Issuance of application (3-5 days prior) <br />Date AVS: Date OSM: <br />AVS Evaluation: <br />OSM Evaluation: <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