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` e o ►qy 9 �E OF COLE)K4DO <br /> s. <br /> • "L:JB'� • q Roy Romer, Governor <br /> I W <br /> DEPARTMW-b "M�94TCES <br /> MINED LAND RECLAMATION DIVISION <br /> FR9D R. SANTA, Director APPLICATION FORM FOR A REVISION <br /> TO A COAL MINING AND RECLAMATION PERMIT <br /> This form must be completed and submitted with all requests for minor revisions, as defined <br /> in Rule 1 .04(73), technical revisions as defined in Rule 1 .04(36) and permit revisions , as <br /> defined in Rule 1 .04(90). All revisions are to address the requirements of Rule 2.08.4. <br /> Three copies of your revision including maps 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 <br /> revised sections, maps, tables and/or figures. Explain in the revision what section is being <br /> revised. The revision date should be printed in the lower right corner of the revision <br /> pages. If necessary, the Table of Contents should also be revised. When the final version <br /> of the revision is approved, 7 copies must be sent to OSM in Denver for Federal mines and for <br /> non-Federal mines 1 copy must be sent to OSM at 625 Silver Avenue, SW, Suite 310, <br /> Albuquerque, New Mexico 87102. The revision may not proceed until OSM has been provided <br /> copies. Copies should be sent certified mail . <br /> Date: 01 — <br /> Permittee: iNATIOlv_L — <br /> • K11�G uU�1�lIVL <br /> — — — — — — — — — — — — — — — <br /> Street: —101 1 LiA;L ji Vh . — — — — — <br /> City: IkRAiVGc) - - - - �. — .� - - - - - - ._.. - - <br /> State: UU Zip Code: <br /> Permit No.: C - 81— - 03. — <br /> Mine Name: hil�G t;OAL <br /> 1S box to be filled1n by tneDivision: <br /> Type of Revision: — — (PR, TR, or MR) <br /> Revision Number: — — (Sequential by Revision Type) <br /> Rev. Submittal Date: — ^/— —/_ — (Date Received by Division) <br /> Rev. Completeness Date: — —/_ _/— — Rev. Incompleteness Date: — <br /> Rev. Adequacy Due Date: — —/— _/— — Rev. Adequacy Date: — _/— <br /> Rev. Decision Due Date: — —/ _/— _ Lead Reclamation Specialist: <br /> Brief escri p 1 on of-Revision: LLt,=�L t1�1 11'1(11� — _ — .— _- —. — <br /> Publ i c Notice Attached - Yes '— -Ao� (tequl rem 1 or_7RTs and7RTs) <br /> Bond Increase: Yes No A ;ederal �_ Non-Federal Mine <br /> Proposed Change in: <br /> Disturbed Area (+/-) U . Acres Affected Area (+/-) 4�s0 ._ Acres <br /> Permit Area (+/-) —`ttr— Acres Federal Land (+/-) _ — Acres <br /> State Land (+/-) —_ Acres Private Land (+/-) _ 467 Acres <br /> 6185F (Rev. 10/88) <br /> 215 Centennial Building, 1313 Sherman Street Denver,Colorado 80203-2273 Tel.(303) 866-3567 <br />