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REQUEST FOR AVS COMPLIANCE CHECKS <br />Permit No: C t 91K l -O (0 Application Type & #: <br />Applicant: ^r MSHA Id No.: <br />?? <br /> <br />1St Check: Adequacy of application (within 30 days of completeness) Co"oy-" wag/d-f <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: 61 0 Date OSM: 1-7 / C <br />AVS Evaluation: ??btahoris??D7? <br />OSM Evaluation: a c-omP--,,A <br />>-?- te wits-w stw o0-r- 6wvt?ns, <br />DMG Recommendation: S <br />-? 1 ottiMg l <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: i,,9f5.ug Date OSM: 7-1- - <br />AVS Evaluation: Si?G( v+ k ibn5 <br />OSM Evaluation: ?..t? u la ins <br />DMG Recommendation: W'AA10 <br />3?d Check: Issuance of application (3-5 days prior) <br />Date AVS: Date O M: <br />C) <br />AVS Evaluation: ?O <br />OSM Evaluation: <br />DMG Recommendation: ?Sl <br />Final Check: After issue/Decision timeframes are over <br />Date of Issue/Decision: <br />Permit Expiration: <br />Permitted Acres: <br />FWD ? s <br /> <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 /> <br />MAcoal\share\forms\Request for AVS Compliance Checks.doc