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STATE OF COLORADO <br /> MINED LAND RECLAMATION DIVISION � ` �" � _ ' co <br /> Department of Natural ResourcesIVf <br /> 1313 Sherman St., Room 215 <br /> Denver.CO 80203JUL <br /> 303 866-3567 1 <br /> FAX: 303 832-8106 <br /> `-c2ii;� �emOr <br /> iT?c)t,�;z' LF11flr,!FtrI�CR.Banta. <br /> APPLICATION FORM FOR A REVISION Uns,onDirector <br /> TO AICOAL 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 crust 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 <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 - 8 1 - p 7 <br /> Date: —7 / 1 7'/ 9 1 <br /> Permittee: Mid-Continent Resources, Ind <br /> Street: 20LLeateunial #40Z — — — — — — — — <br /> City: G.].eau=LS4rizzg -- - - - - - - - - - - - - - <br /> State: r 7i p Code: &_1—6.0 1 <br /> Mine Name: -LoAl Basin Mine. — <br /> Brief Description of Revision: _ <br /> Public Notice Attached - Yes X — No — (Required for PR's and TR's) <br /> Bond Increase: Yes No X Federal X Non-Federal Mine <br /> Proposed Change in: <br /> Disturbed Area (+/-) — — — — Acres Affected Area (+/-) _ — — Acres <br /> Permit Area (+/-) — — —.— Acres Federal Land (+/-) _ — i Acres <br /> State Land (+/-) — Acres Private Land (+/-) — — Acres <br /> 6185F (10/90) <br />