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°v `°� - 5TATE OF COLORADO <br /> tee/ O <br /> Roy Romer, Governor <br /> */876 <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: c� i 0 _ C �_ it i L !G 1l REC <br /> VD <br /> Street: i� � x -,CC - - - - - - - - APR 41390 <br /> MINED LAND <br /> — — — — — RECLAMATION DIVISION <br /> City: C' F; v C i �-' t- — — - - - - - - - - - - <br /> State: C) Zi p Code: — <br /> Permit No.: C - / - 7 <br /> Mine Name: C eq Z — � t� `D _ A-'— mil AU F 5 - - - - <br /> 1s box to be filled in by the Division: <br /> Type of Revision: l�( (PR,_ TR, or MR) <br /> Revision Number: (Sequential by Revision Type) <br /> Rev. Submittal Date: f C/j::� t( /_2C-' (Date Received by Division) <br /> Rev. Completeness Date: �1 /���/� CJ Rev. Incompleteness Date: — —/— —/— — <br /> Rev. Adequacy Due Date: — —/— —/_ — Rev. Adequacy Date: — —/— —/— — <br /> Rev. Decision Due Date: �{/1 /�` Lead Reclamation Specialist: Gi-' / C <br /> Brief escri p 1 on Ot Revision: ,4, 62- — 5 T /`� T Z C i — <br /> 1A U- F_ K _ <br /> Public Notice Attached - Yes '�o Requlrea �r_7R s and TR s ) <br /> Bond Increase: Yes No ice eral t�- 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 />