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STATE OF COLORADO <br /> r-JINED LAND RECLAMATION DIVISION <br /> Department of Natural Resources <br /> 1313 Sherman St., Room 215 <br /> Denver.CO 80203 <br /> 303 866.3567 187' <br /> FAX: 303 832-8106 <br /> `�Rorrer, <br /> _ �emor <br /> Fred R Banta. <br /> APPLICATION FORM FOR A REYISION MnsionDire^.or <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 rQquirements or 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: „ 6.—/ Z,4,/ 9— 1. <br /> Permittee: Mid-Continent Resources, Ind <br /> Street: 2DLG eat aun i.,Q -.44A6 — — — — — — — <br /> City: UeE=od_ SW lag <br /> State: r 7i p Code: g_ L 6_ 0 1 - — — — — <br /> Mine Name: Caa] -Basin-Vi.rae- - - - - - - - - - -- - - - - <br /> Brief Description of Revision: Take ri p_rag,fj_gtr_.arra j,eax_Uutc.L_L=ek_ — — <br /> Public Notice Attached - Yes — No (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 /> 6195F (10/90) <br />