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L. <br /> STATE OF COLORADO <br /> MINED LAND RECLAMATION DIVISION <br /> Department of Natural Reswren <br /> a <br /> 1313 Sherman St..Room 215 <br /> Denver.CO 80203 f Ail Y, A f <br /> 303 866-3567 . . <br /> FAX. 303 832-8106 `1476` <br /> • Roy Ronrr. <br /> Govwv <br /> R.Banta. <br /> APPLICATION FORM FOR A REVISION FrW D <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 - $ j _ 0 Z <br /> Date: / E <br /> Permittee: AL I b_coorlme- VT /2ES0t ke g-s <br /> Street: <br /> City: kL.EltI�D�O —�piel�tl <br /> State: e D Zip Code: .91 j. Q Z <br /> Mine Name: Q. --fL A&&— ^,[IN1 <br /> Brief Description of Revision: CV <br /> ._. .._. - - - - - - - - - - <br /> Public Notice Attached - Yes — No >C (Required for PR's and TR's) — — <br /> Bond Increase: Yes No Federal Non-Federal Mine <br /> Proposed Change in: <br /> Disturbed Area (+/_) — — p Acres Affected Area (+/_) O Acres <br /> Permit Area (+/_) Acres Federal Land •— <br /> — ._. Q•_. (+/-) � Acres <br /> State Land (+/-) — — 0 Acres Private Land (+/_) _ �_ Acres <br /> 6185F (10/90) — <br />