1991-11-18_REVISION - C1981035 (4)

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STATE OF COLORADO MINED LAND RECLAMATION DIVISION oF.Co� Department of Natural Resources 1313 Sherman St., Room 215 Denver,CO 80203 — v2,— j 303 866-3567 */876 FAX: 303 832-8106 Roy Romer, Governor Fred R.Banta. APPLICATION FORM FOR A REVISION Division Director TO A COAL MINING AND RECLAMATION PERMIT 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(36) 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 your 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. Explain in the revision what section is being revised. The revision date should be printed in the lower right corner of the revision pages. If necessary, the Table of Contents should also be revised. When the final version of the revision is approved, 7 copies must be sent to OSM in Denver for Federal mines and for non-Federal mines 1 copy must be sent to OSM at 625 Silver Avenue, SW, Suite 310, Albuquerque, New Mexico 87102. The revision may not proceed until OSM has been provided copies. Copies should be sent certified mail . Permit No.: C - ' I - L Date: C1I Permittee: t = � !- _ L _i Street: City: State: L-L Zip Code: Mine Name: L"�. _ L1 _ _ _ _ � _ _ _ _ - _ Brief Description of Revision: 1 11 _. ,.5 � � Ls1 �C Public Notice Attached - Yes '�C No (Required for PR's and TR's) Bond Increase: Yes No Federal Non-Federal Mine Proposed Change in: Disturbed Area (+/-) Acres Affected Area (+/_) Acres Permit Area (+/-) Acres Federal Land (+/_) Acres State Land (+/_) Acres Private Land (+/-) Acres 6185F (10/90)