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MINED LAND RECLAMATION DIVISION <br />Department of Natural Resources <br />1313 Sherman St., Room•215 <br />Denver. CO 80203 <br />303 866 -3567 <br />FAx: 303 832 -8106 <br />This form must be completed and submitted with all <br />revisions, as defined in Rule 1.04(73), technical <br />Rule 1.04(36) and permit revisions, as defined in <br />revisions are to address the requirements of Rule <br />your revision including maps must be submitted in <br />Permit No.: C- 8 1- 0 1 7 <br />D ate : "AL 5 .. / _, -fl- 2... <br />P ermittee: dL_Quti - 1ent`Resc cas -, <br />Street: <br />Proposed Change in: <br />Disturbed Area ( +/ -) <br />Permit Area ( + / -) <br />State Land ( <br />6185F (10/90) <br />APPLICATION FORM FOR A REVISION <br />TO A COAL MINING AND RECLAMATION PERMIT <br />BQ x_123 8_. <br />/11•01. •MMMIIIM <br />• <br />sequence. <br />Acres <br />Acres <br />Acres <br />STATE OF COLORADO <br />City: <br />State: (1_ Zip Code: 8-1-.6-0 — <br />Mi ne Name: Q ..04. 1 . 8 aL z> lie <br />Brief Description of Revision: <br />Affected Area ( + / -) <br />Federal Land ( +/ -) <br />Private Land ( + / -) <br />Roy Romer, <br />Governor <br />' Fred R. Banta. <br />Division Director <br />requests for minor <br />revisions as defined in <br />Rule 1.04(90). All <br />2.08.4. Three (3) copies of <br />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 mist 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 />RECE <br />CIA Y 0 7 199; <br />Mined Land <br />Rergarn t;nn n <br />cilan22 ASS _Lu mberiug mar- carrec.t_ — — <br />Public Notice Attached - Yes No x (Required for PR's and TR's) <br />Bond Increase: Yes No Federal ._— Non- Federal Mine <br />Acres <br />Acres <br />Acres <br />