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U, h L �, <br /> `° I STATE OF COLOFADO <br /> *' 77, k/* Roy Romer, Governor <br /> 1876 <br /> DEPARTMENT OF NATURAL RESOURCES <br /> MINED LAND RECLAMATION DIVISION <br /> FRED R. BANTA, Director 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 defined <br /> in Rule 1 .04(73), technical revisions as defined in Rule 1 .04 (36) and permit revisions , as <br /> defined in Rule 1 .04(90). All revisions are to address the requirements of Rule 2.08.4. <br /> Three copies of 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 replace the <br /> revised sections, maps, tables and/or figures. Explain in the revision what section is being <br /> revised. The revision date should be printed in the lower right corner of the revision <br /> pages. If necessary, the Table of Contents should also be revised. When the final version <br /> of the revision is 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 310, <br /> Albuquerque, New Mexico 87102. The revision may not proceed until OSM has been provided <br /> copies. Copies should be sent certified mail . <br /> Date: <br /> Permittee: /1� L (� - c C v dL' <1 T— — <br /> Street: L� I — C 1 ► r_ L' /L 1- — <br /> City: G L rev C/ - - - - <br /> State: C", Zip Code. — — — — — - — — — — <br /> Permit No.: C - 2? l - C l 7 <br /> Mine Name: L. (_�. /� Z — i2 i Z !, - <br /> 1s box to be filled in by the Division: / <br /> Type of Revision: (PR, TR, or MR) Cj <br /> Revision Number: 7 (Sequential by Revision Type) i,/ <br /> Rev. Submittal Date: r �L/c) /�'� (Date Received by Division) <br /> Rev. Completeness Date: C Z / Rev. Incompleteness Date: — <br /> Rev. Adequacy Due Date: — —/— —/— — Rev. Adequacy Date: — —/— —/— — <br /> Rev. Decision Due Date: Ci ; /L'j/L Lead Reclamation Specialist: — — — <br /> Brief escrip ion of Revision: LI —tir`_T �L -— 1 <br /> Public Notice Attached - Yes No Requ1 reN T-5rNR 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 /> 6185F (Rev. 10/88) <br /> 215 Centennial Building, 1313 Sherman Street Denver, Colorado 80203-2273 Tel.(303) 866-3567 <br />