2009-02-04_REVISION - C1994082 (3)

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• Fr? ` g COLORADO DIVISION OF RECLAMATION, MINING AND 1313 Sherman Street, Room 215, Denver, Colorado 80203, (303) 81OPV APPLICATION FORM FOR A REVISION Division of Reciamation, TO A COAL MINING AND RECLAMATION PERMIT Mining and Safety This form must be completed and submitted with all requests for minor revisions, as defined in Rule 1.04(73), technical revisions, as defined in Rule 1.04(136), and permit revisions, as defined in Rule 1.04(90). All revisions are to address the requirements of Rule 2.08.4. Three (3) copies of the revision, including maps, must be submitted in order for it to be complete. All revisions are to be formatted so they can be inserted into the permit to replace the revised sections, maps, tables and/or figures, with a revised table of contents, if necessary. The revision submittal date should be printed in the lower right corner of each revision page. A cover letter to the revision should explain the nature of the revision and reference the specific permit sections being revised. For federal mines, a copy of the revision application must be submit-red t„ all agencies on the felierai mAino licT (except OSND at the same time the application is submitted to the Division, and proof of distribution must be : cd rPvjI inn n9c, S mnf11f d-d ._hirino ri?Y rPCwcv nrnrP4g 11-M-17 . _ •?S,Tr_*-r Lr•. _IP -;_ip__e m, nner. 2.:(,i g \tlth proor' of distnbution. Proot of (nsLnbuuon must be submitted ?"or rr; s r i Y _r'-n of rye re; i_.rr;- r---- - --r - i)n-«,.wt A(;. !` iiA f?G'7 i)t`• •l E-ni-i:a Cisml comp--inn a "tj P.O. Box 00 City: 14avden State: CO _ Zip Code: 8I&W - 0'2 •l!i(iti Brief Description of Revision: J-.11-40, Sediment Pond 012A As-Built Public Notice Attached: Yes x No (&quired for l'Rr and I Rs) Bond Increase: Yes No x Federal x Non-Federal Proposed Change in: Mine Ownership Ownership 12