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of CO<o <br />N! ?_ '?8 <br />COLORADO D ISION OF MINERALS AND GEOLOGY <br />+?• 1313 Sherman Stre , Room 215, Denver, Colorado 80203, (303) 866-3567 <br />? 1876 <br />" <br />R N[22 C <br />APPLICATION FORM FOR A REVISION <br />TO A COAL MINING AND RECLAMATION PERMIJT C Q 72009 <br />Division or Kecllamation, <br />Min, <br />This form must be completed and submitted with all requests for minor revisions, as def edrin Rau eY1.04(73), <br />technical revisions, as defined in Rule 1.04(136), and permit revisions, as defined in Rule 1.04(90). All <br />revisions are to address the requirements of Rule 2.08.4. Three (3) copies of the revision, including maps, <br />must be submitted in order for it to be complete. <br />All revisions are to be formatted so they can be inserted into the permit to replace the revised sections, maps, <br />tables and/or figures, with a revised table of contents, if necessary. The revision submittal date should be <br />printed in the lower right corner of each revision page. A cover letter to the revision should explain the nature <br />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 (except OSM) at the same time the application is submitted to the Division, and proof of distribution must <br />be submitted to the Division along with the application. Copies of revision pages modified during the review <br />process must be distributed in the same manner, along with proof of distribution. Proof of distribution must <br />be submitted prior to implementation of the revision. <br />Permit No.: C - 8 I - o14 Date: ?2 5 / o q <br />Permittee: E N i?(ZGY EU E L S C o AIL, 1 'IS G <br />Street: PO Box- 45`3 <br />( 15 eAGT MAIN S?T <br />City: I ..DkF_r ICE <br />State: co Zip Code: <br />Brief Description of Revision: F g0uG ST --ro i ERM I t4 A-11. WAS I- <br />GAMFLYIJ&?PrI`?/?LY5-( im EJA.I? G2L-?t< <br />5Alvl P LE 5 LEES ° ©C I t QC 2 <br />Public Notice Attached: Yes X No - (Required for PRs and TRs) <br />Bond Increase: Yes - No X Federal _ Non-Federal )< Mine <br />Proposed Change in: <br />Disturbed Area (+/-) - _ © O Acres Affected Area (+/-) - _ o Acres <br />Permit Area (+ O Acres Federal Land a O Acres <br />State Land (+ l-) _ _ D 0 Acres Private Land ( + l-) _ _ 0 0 Acres