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of.00 <br /> DEPARTMENT OF NATURAL RESOURCES <br /> David H Getches,Executive Director <br /> MINED LAND RECLAMATION DIVISION <br /> 1876 * DAVID C.SHELTON, Director <br /> i <br /> Richard D.Lamm <br /> Governor 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: 04 o <br /> Perinittee: #I E C <br /> M I D IZI�L Z 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 — MAY Q 3 1190 <br /> S _U I T E _ 4 0 6 MINED LAIN® <br /> City: �, E N W 0 O D — S P R I N G S - - wtATIQN Djf o1"i <br /> State: C 0 Zip Code: Q L - — — — — <br /> Permit No. : C - _ Z - 2 _a _j_ <br /> This box to be filled in by the Division: <br /> Type of Revision: M E_ (PR, TR, or MR) <br /> Revision Number 2 5 (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: 1L P I A T E — O P E R A T I O N S <br /> P L A N - - - - - - - - - - - - - <br /> Public Notice Attached - Yes No (Required for PR's and TR's) <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 />