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��of cow <br /> DEPARTMENT OF NATURAL RESOURCES <br /> N <br /> o * David H.Getches,Executive Director <br /> MINED LAND RECLAMATION DIVISION <br /> x 1876 DAVID C.SHELTON, Director <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 Rule 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: o j_/ 0 4 / 9 0 <br /> Permittee: MID - CONTINENT RESOURCES — — — — <br /> Street: 2 0 1 CENTENNIAL SUITE 406— <br /> City' GLENWOOD SPRINGS - - - - - - - - - - - - ;• PR <br /> State: C o Zip Code: 8 1 6 0 1 <br /> Permit No. . C - 8 1 - 0 1 7— :'--, �•4, .1tf-'ps r .e <br /> This box to be filled in by the Division: <br /> Type of Revision: M R (PR, TR, or MR) <br /> Revision Number _ _ (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: CHANNEL WORK- - - - <br /> Public Notice Attached - Yes No (Required for PR's and TR's) <br /> Bond Increase: Yes No X <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 W A C 6185F <br /> 423 Centennial Building, 1313 Sherman Street Denver, Colorado 80203 Tel.(303) 866-3567 <br />