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III 999 <br /> STATE 0FC0L0FllllllAD0 <br /> Roy Romer, Governor <br /> DEPARTMENT OF NATURAL RESOURCES <br /> MINED LAND RECLAMATION DIVISION <br /> FRED R. BA?l DlfW*r APPLICATION FORK FOR A REVISION <br /> TO A COAL MINING AND RECLAMATION PERMIT <br /> This form must be completed and submitted with all requests* <br /> for <br /> minor) and revisions, a onsf ined <br /> in Rule 1 .04(73), technical revisions as defined in <br /> as <br /> defined in Rule 1 .04(g0). All revisions are to address the <br /> regiirementsorderfof Ruleo .be <br /> 08co;npiete <br /> Three copies of your revision including maps <br /> must be All revisions are to be formatted so they can•beEinsertelain dninto <br /> the the <br /> perevisio it t section isce being <br /> revised sections, maps, tables and/be figures. <br /> rinted in the lower right corner of the revision <br /> revised. The revision date should be p <br /> When the fi.^.31 version <br /> -+ages . If necessary, the Table of Contents should also be revised. <br /> of the revision necessary <br /> is approved, 7 copies must be sent to 0Sm in Denver fore-federal mines <br /> non-Federal mines 1 copy must be sent to OSM at 625 Silver Avenue, SW, Suite 310, <br /> :,Ibuquerque, New Mexico 87102. The revision may not proceed until OSM has been provi;ed <br /> copies . Copies should be sent certified mail . <br /> Date: / _/ z- Z/ g,3 <br /> j7 <br /> �., �, s J A; 2 C'�S <br /> Permi4,tee: — - <br /> - - 6_ Lz_ <br /> ,Lreet: _ — — -- 14 <br /> State: Zip Code: — — — — — - - - -- <br /> Permi t No. C - / - �' 3 <br /> ;sine game: _��' G7�_ ti —� f�G L - - - - - - - - - <br /> is box o e 1 e 1n y e 1y1s1on: <br /> _ <br /> Type of Revision: j�� (PRE TR or MR) <br /> Revision Plumber: — _ (Sequential by Revision Type) <br /> Rev. Submittal Date- / —/_. _ (Date Received by Division) <br /> • — —/_,,, _/._ — Rev. Incompleteness Date: <br /> Rev. Completeness Date <br /> . <br /> Rev. Adequacy Due Date: Rev. Adequacy Date:— —/— —� „_ — — <br /> Rev. Decision Due Date: — / � _. <br /> Lead Reclamation Specialist:77— <br /> _ <br /> brief e sc ri p i on o evi sv on: �_, : <br /> Public 11otice Attached - Yes -96" re� r79 s and-TR s) <br /> Bond Increase: Yes Flo ,+� feral _ non-Federal <br /> ►•?i ne <br /> Proposed Change in: Acres <br /> I sturbed Area t+/-) _ Acres Affected Area (+l-) Acres <br /> verni t Area (+/-) — — _, _ Acres Federal Land (+/-) _ ._ — Acres <br /> State Land (+/-) — — Acres Private Land <br /> 6185E (Rev. 10/88) <br /> Street Denver,Co�orado 80203.2273 Tel.(303) 866.3567 <br /> 215 Centennial Building, 1313 Shetmen <br /> ors - - <br />