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r <br /> r <br /> STATE OF COLORADO <br /> MINED LAND RECLAMATION DIVISION of_coc��> <br /> Department of Natural Resources <br /> 1313 Sherman St.,Room 215 <br /> Denver,CO 80203 + ' <br /> 303 866-3567 '1e76` <br /> FAX: 303 832-8106 <br /> Roy Romer. <br /> Governor <br /> Fred R.Banta. <br /> APPLICATION FORM FOR A REVISION Division Director <br /> TO A COAL MINING AND RECLAMATION PERMIT <br /> This form must be completed and submitted with all requests for minor <br /> revisions , as defined in Rule 1 .04(73), technical revisions as defined in <br /> Rule 1 .04(36) 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 <br /> your revision including maps trust be submitted in order for it to be complete. <br /> All revisions are to be formatted so they can be inserted into the permft to <br /> replace the revised sections, maps, tables and/or figures. Explain in the <br /> revision what section is being revised. The revision date should be printed <br /> in the lower right corner of the revision pages. If necessary, the Table of <br /> Contents should also be revised. When the final version of the revision is <br /> 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 <br /> 310, Albuquerque, New Mexico 87102. The revision may not proceed until OSM <br /> has been provided copies. Copies should be sent certified mail . <br /> Permit No.: C \ /L. <br /> Date: / —/9�- — � it i_... <br /> ID <br /> Permittee: Mid„Conti�} t,�Ze o c.�S_ _ _RE — <br /> Street: 818 Colorado <br /> — 9Vi�tit;c� �_drlci <br /> P_C_B,.QX.1Z,8_ , t 1e�sSiOn <br /> City• — — —. RecTar�.a, �r, �• — — — <br /> State: gyp— Zip Code: R I LD 2_ <br /> Mine Name: C-ea-l-Basin •M-irr e — — — — — — — — —Brief Description of Revision: _Ue v a. �aQ� 4. ale--,I-an— — — — — —. <br /> Public Notice Attached - Yes r_ No — — (Required for PR's and TR's) <br /> Bond Increase: Yes No Federal Non-Federal Mine <br /> Proposed Change in: <br /> Disturbed Area (+/-) — — —.— Acres Affected Area (+/-) — —.— Acres <br /> Permit Area (+/-) — — — — Acres Federal Land (+/-) — — Acres <br /> State Land (+/-) Acres Private Land (+/-) — — Acres <br /> 6185F (10/90) <br />