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STATE OF COLORADO <br /> MINED LAND RECLAMATION DIVISION F CO <br /> Department of Naturaf Resources ���� <br /> 1313 Sherman St.,Room 215 <br /> Denver.CO 80203 +�✓ • <br /> 303 866-3567 ;1876' <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 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 <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_ L <br /> Date: 8 —I 3— <br /> Permittee: CQ�ner,t 4L11.CE$, <br /> Street: 818 Colorado Ave.— <br /> City: Glenwood Springs, Co — <br /> State: C 0 Zip Code: 8 1 6—0 1 <br /> Mine Name: C.Qal.aasiD .Mine <br /> Sri of Descri pti on of Revi si on: <br /> Public Notice Attached - Yes x — No — — (Required for PR's and TR's) <br /> Bond Increase: Yes No — Federal X - Non-Federal Mine <br /> Proposed Change in: <br /> Disturbed Area (+/-) — — — — Acres Affected Area (+/-) — — —.— Acres <br /> Permit Area (+/-) i — i i Acres Federal Land (+/-) — — — Acres <br /> State Land (+/-) Acres Private Land (+/-) i — , Acres <br /> , 185F (10/90) <br />