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��pF C 0 <br /> Q -Xgr� 90 <br /> o DEPARTMENT OF NATURAL RESOURCES <br /> ♦ t o +` k David H.Getches.Executive Director <br /> 6 MINED LAND RECLAMATION DIVISION <br /> lg� DAVID C. SHELTON, Director <br /> Richard D.Lamm <br /> i <br /> GOVef"°' APPLICATION FORM FOR A REVISION <br /> TO A COAL MINING AND RECLAMATION PERMIT —This form must be completed and submitted with all requests for minor revisions, as <br /> defined in Rule 1 .04(73), technical revisions as defined in Rule 1 .04(36) and permit <br /> revisions, as defined in Rule 1 .04(90). All revisions are to address the requirements <br /> of Rule 2.08.4. <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 <br /> being revised. The revision date should be printed in the lower right corner of the <br /> revision pages. If necessary, the Table of Contents should also be revised. <br /> Date: A/ N 2 / .8 .8 <br /> Permittee: ..P. _AB— QJL- Y — FQ A L - - - <br /> GG M P A N Y - - - - - - - - <br /> Street: 1 � _9 — � QUZF — Y A L E <br /> City: ASzN T A F F - - - - - - - - - - - <br /> State: A 1 Zip Code: s`i_ _L .o o 1 - — — — — <br /> Permit No. : C - _ - L oA <br /> This box to be filled in by the Division: <br /> Type of Revision: — — (PR, TR, or MR) <br /> Revision Number — — (Sequential by Revision Type) <br /> Revision Submittal Date / / (Date Received by Division) <br /> Revision Completeness Date —/ / Revision Incompleteness Date <br /> Revision Adequacy Due Date —/ / Revision Adequacy Date <br /> Revision Decision Due Date / / Fee $0.00 <br /> Brief Description of Revision: - I I r I — A T T — — — — — <br /> -L - NL1 N G — A R E A - - - - - - <br /> Public Notice Attached - Yes _x No (Required for PR's and TR' s) <br /> Bond Increase: Yes _y No <br /> Proposed Change in: <br /> Disturbed Area Q+/-) 2 4 . Acres Affected Area (9-) 2 3 4 . 5 Acres <br /> Permit Area (( -) 2 3 4 .� Acres Federal Land (v/-) — — O Acres <br /> State Land (+/-) — — n Acres Private Land ( -) �, 5 Acres <br /> Lead Reclamation Specialist 6185F <br /> 423 Centennial Building, 1313 Sherman Street Denver, Colorado 80203 Tel. (303) 866-3567 <br />