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f r i 'yi'Y,7z. <br /> tE�a'zb }A Y,; > :jr y.3.. rho ' S `r.,,•'tw a: <br /> e .. _ r } t •tom <br /> � t k .STATE OF COLUR,ADO x <br /> 1 DIVISION OF MINERALS AND GEOLOGY <br /> 'Department of Natural Resources <br /> 313 Sherman St.,Room 215 <br /> Denver Colorado 80203 ,a�l,� a.}� 9pp <br /> Phone (303)866-3567 <br /> FAx (303)s3z 8106 APPLICATION FORM FORA REVISION <br /> TO A COAL MINING AND'RECLAMA7I� ��jl 'T"gr l� .O��l y D1P�TNIFI F <br /> .NATURAL <br /> RESOURCES <br /> This form must be completed and submitted with all requests for minor revisions, as defined in Roy Rome <br /> Rule 1.04(73), technical revisions, as defined in Rule 1.04(136), and permit revisions, as defined Governor <br /> ... in Rule 1.04(90). All revisions are to address the requirements of Rule 2,08.4. Three (3) copies JamesS.Lochhead <br /> of the revision, including maps, must be submitted in order.for it to be complete. Executive Director <br /> Michael B.Long <br /> All revisions are to be formatted so they can be inserted into the permit to replace the revised Division Director <br /> sections, maps, tables and/or figures,'wit'h a revised table of contents,-if necessary. The revision <br /> submittal date should be printed in the lower right corner of each revision page. A cover letter to the <br /> revision should explain the nature of the revision"and reference the specific permit sections being revised. <br /> For federal mines, a copy of the revision application must be submitted to all agencies on the federal mailing <br /> list at the same time the.application is submitted to the-Division; and proof of distribution must be'submitted <br /> to the Division along with the application. Copies of revision pages modified during the review process.must <br /> be distributed in the same manner', along with proof of-distribution. Proof of distribution must be submitted <br /> prior to.implementation of the revision. For non-federal mines,a copy of the application•for which the <br /> Division has issued a proposed approval decision must be submitted to.the OSM Albuquerque Field Office <br /> (AFO); and proof of submittal to AFO must be submitted to the Division prior to implementation of the <br /> revision. <br /> Permit No.: C Date-. 2o- -7-/ $_/ <br /> Permittee o a <br /> C o m, D :a n: , <br /> Street: o o <br /> Q - 0 <br /> R ,^j <br /> .....1..� �'•..Y i <br /> C!tY s3. — -A rL . Q <br /> r - — <br /> State T X !Zip Code �3 2 _O' :] p 0. <br /> Brief Description of Revision:.,,,- <br /> e e s s t. i o n o f _ — <br /> " e et h . n c a 1 W e 1 1 <br /> Public Notice Attached: Yes"X-- No (Required foi Ms and TRs) <br /> Bond Increase: Yes No X Federal _ ',Non-Federal X "Mine <br /> Proposed Change in: <br /> Disturbed Area Q Acres: Affected Area (+/-) 0_ . . Acres <br /> Permit Area (+/-) _ Q 0 ` Acres : Federal Land (+/-) 0 0 Acres <br /> State Land Acres -Private Land (+/-) _ _0 . 0 Acres <br /> m:\co al\share\forms\886 5 <br />