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STATE OF COLORADO <br /> MINED LAND RECLAMATION DIVISION F `o <br /> Department of Natural Resources j ,' <br /> 1313 Sherman St.,Room 215 <br /> Denver,CO 80203 •`<s,,•�• <br /> 303 866-3567 '1876' <br /> FAX: 303 832-8106 <br /> fey Roma. <br /> Governor <br /> Fred R.Banta, <br /> APPLICATION FORM FOR A REVISION Oivision 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 <br /> Date: <br /> a_/ <br /> Permittee: micL- <br /> .an#..inwn -g "r.�3... <br /> Street: <br /> P.O. Box 129 <br /> City: Glenwog_(2 apoingas <br /> State: f0� Zip Code: .,1,,2— <br /> Mine Name: Coal Basin MiLe — <br /> Bri of Descri pti on of Revi si on: QbjLaiz. j p _r&ja <br /> Public Notice Attached - Yes No . -- (Required for PR's and TR's) <br /> Bond Increase: Yes No .�_ Federal -X Non-Federal Mine <br /> Proposed Change in: <br /> Disturbed Area (+/-) ^ .� i.� Acres Affected Area (+/-) i _ _ Acres <br /> Permit Area (+/-) Acres Federal Land (+/-) _ Acres <br /> State Land (+/-) Acres Private Land (+/-) i Acres <br /> 6185F (10/90) <br />