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DEPARTMENT OF NATURAL RESOURCES <br /> David H.Getche&Executive Director <br /> \yS�✓"Y/* MINED LAND RECLAMATION DIVISION <br /> 1876 DAVID C.SHELTON,Director <br /> i <br /> Richard D.Lamm <br /> Govemor APPLICATION FORM FOR A REVISION <br /> TO A COAL MINING AND RECLAMATION PERMIT <br /> This form must be completed and submitted with all requests for minor revisions, as <br /> defined in Rule 1.04(73), technical revisions as defined in Pule 1 .04(36) and permit <br /> revisions, as defined in Rule 1 .04(90). All revisions are to address the requirements <br /> of Rule 2.08.4. <br /> All revisions are to be formatted so they can be inserted into the permit to replace the <br /> revised sections, maps, tables and/or figures. Explain in the revision what section .is <br /> being revised. The revision date should be printed in the lower right corner of the <br /> revision pages. If necessary, the Table of Contents should'also be revised. <br /> Date: 0 8 / 0 6 / 9 0 <br /> Permittee: M I D - C 0 N T I N E N T _ _ <br /> R E S O U R C E S <br /> Street: 2 0 1 C E N T E N N I A L _ <br /> S U I T E _ 4 0 6 <br /> City: G L E N W 0 0 D _ S P R I N G S <br /> State: C o Zip Code: 8 1 6 0 1 <br /> Permit No. : C - 1 7 - 0 8 1 <br /> This box to be filled in by the Division: <br /> Type of Revision: M R (PR, TR, or MR) <br /> Revision Number 3 0 (Sequential by Revision Type) <br /> Revision Submittal Date _/_/ (Date Received by Division) <br /> Revision Completeness Date / / Revision Incompleteness Date <br /> Revision Adequacy Due Date _/ / Revision Adequacy Date <br /> Revision Decision Due Date / / Fee $0.00 <br /> Brief Description of Revision: MAI N T EN - AN C E <br /> 5 _ P1 I N E <br /> Public Notice Attached - Yes No (Required for PR's and TWO <br /> Bond Increase: Yes No <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 /> Lead Reclamation Specialist _ _ _ 6185F <br /> 423 Centennial Building, 1313 Sherman Street Denver, Colorado 80203 Tel. (303) 866-3567 <br />