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• STATE OF COLORADO <br /> MINED LAND RECLAMATION DIVISION of cocoa <br /> Department of Natural Resources _> <br /> �j <br /> 1313 Sherman St.,Room 215 <br /> Denver,CO 80203 <br /> 303 866-3567 #/876• <br /> FAX: 303 832-8106 <br /> Roy Romer. <br /> Governor <br /> Fred R.Banta. <br /> APPLICATION FORM FOR A REVISION OnnsionDirector <br /> TO A COAL MINING AND RECLAMATION PERMIT <br /> This form must be completed and submitted with aTl 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 - 8 1 - 0 1 7 <br /> Date: 1 0 / 2 2 / 9 1 q <br /> Perm;ttee: _Mira-LQnti nAlit 8es.ales — — —„ a `� <br /> Street: 818 Colter dg <br /> P.O. Box 122L �C) <br /> MIt12ci La <br /> City: G�rLSdOad �.prir>�s _ _ �.. _ — _ _ @CT lA1rt 1I�;aL <br /> State: C 0 Zip Code: 81602 — <br /> Mine Name: Coal B pia JLi11eBrief Description of Revision: Sew jLiz_f.Qx,xo,ad lag_ <br /> Public Notice Attached - Yes No x (Required for PR' s and TR's) <br /> Bond Increase: Yes No Federal 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 /> 5185F (10/90) <br />