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FROM Panasonic TAD/FAX PHONE NO. 9454958 Jun. 30 1994 12:10PM P02 <br /> STA J..i V":-" COLO O <br /> MINED LAND 14ECLAMATION DIVISION <br /> Depan"nt of WOW F169wreas �1 <br /> 1313 Sherman St.,Room-215 • � <br /> Denver.CO 80203 1 76« <br /> 303 868.3567 - -- <br /> FAX: 303 832.11106 ftypa,w. <br /> ' Cio++mor <br /> Fred H.8acma. <br /> AP-PLICATION FORM FOR A REVISION DmsionArecw <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 .0 <br /> 4(90). All <br /> reviions are oursrevision includingsmaps must the ibemsubmitted in order ents of Rule 4for Titeto{be complete. <br /> 3) copies of <br /> yours <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, Sot, 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 <br /> Date: 6/ 3 d/ 9 4 <br /> Permittee: -„�or�ti,�e> — <br /> Street: <br /> City: .G1enW0tsd :.pra.n98 -CrD.. <br /> State: .�, ..l? dip Code: JL _1 L., .0 2- <br /> Mine Name: Coa1,_BiSln�Brief Description of Revision: l, w, <br /> Public Notice Attached - Yes No (Required for PR's and TR's) <br /> Bond Increase: Yes No X,._ Federal _Z_ Non-Federal Mine <br /> Proposed Change in: None <br /> Disturbed Area (+/-) i•,,,_, Acres Affected Area (+!-) _ Acres <br /> Permit Area (+!-) ,_„ �, Acres Federal Land (+/�) w Acres <br /> State Land (+/-) Acres private Land (+/-) Acres <br /> r1tiatir flAl4n1 <br />