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STATE OF COLORADO <br /> MINED LAND RECLAMATION DIVISION of.cow <br /> Department of Natural 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.Santa, <br /> APPLICATION FORM FOR A REVISION Mnsion 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 - - Z - ,_ mil, �., �` i\ [�.. <br /> Date: Z 2_/ Z Z/ .g ]... S E C E 1 V L,L <br /> Permittee: -r nfi nonpyr�c� �- <br /> - - _ DEC 131991 <br /> Street: $18_QQjnrado_. •—. •— —, — — .—. — — <br /> Mined Land <br /> o,r 19oyr-•1'2-9 8— — _. _ — _. ._ RPcIamation Dive;.. <br /> City: Glenwood Springs, CO 81602 _, _ _ <br /> State: C-O_ Zip Code: Q--1 6b 9 ,_ , i _ — <br /> Mine Name: Coal Basin Mine- - <br /> Brief Description of Revision: Management of non-coal waste,- <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 (+/-) i _ i Acres Affected Area (+/-) _ _ _ Acres <br /> Permit Area (+/-) _ a i Acres Federal Land (+/-) .— i Acres <br /> State Land (+/-) Acres Private Land (+/-) ` i Acres <br /> 6185F (10/90) <br />