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STATE OF COLORADO <br /> MINED LAND RECLAMATION DIVISION of cow <br /> Department of Natural Resources � �yQ <br /> 1313 Sherman St.,Room 215 <br /> Denver.CO 80203 +�* <br /> 303 866-3567 <br /> Fax: 303 832-8106 <br /> Aay Romer. <br /> Govemor <br /> Fred R.Banta. <br /> APPLICATION FORM FOR A REVISION DivisionDirec;or <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 ` q ,Date: Z 2_/ -I- 2./ -a. J_ � ��1J�� V <br /> Permittee: .rLid_C,�tin.o.ut � 4.. <br /> .�i�coa <br /> rses—• —. —. — —. —. <br /> _ _. _ - _ - .- - -• -- - - - DEC 131991 <br /> Street: Eat _.CDjr)rrar, — — _ _ — _ — — <br /> iVlined Land <br /> P-.oT �e ��-9 s— — — — — — — — — o^�amation Dive:- <br /> City: Glenwood Springs, CO-81602 <br /> State: O_ Zi p Code: <br /> Mine Name: Coal Basin Mine— <br /> Brief Description of Revision: Management of non-coal wastes <br /> Public Notice Attached - Yes _ 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 (+/-) — — — Acres <br /> State Land (+/-) — ` Acres Private Land (+/-) _ — — Acres <br /> 6185F (10/90) <br />