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of.CO <br /> DEPARTMENT OF NATURAL RESOURCES <br /> o * David H.Getches,Executive Director <br /> M"j * MINED LAND RECLAMATION DIVISION <br /> 1876 DAVID C.SHELTON, Director <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: 0 8/ O l / 8 9 <br /> Permittee: M I D C O IZLILZ- N -T- — v o <br /> R E S 0 --Lj --3 —C --E --Ss --N -I-- AUG z1889 <br /> Street: 2 0 1 -Q -L --N -T E --u - s -S-T- Rec MINED I AND <br /> s U I T E 4 LA <br /> 4 0 6 - - - - - - MATIONOIVISI06V <br /> City: G L E N W 0 --Q -12 -E ,E -R T -T _G_5 - - - - - <br /> State: C 0 Zip Code: 8 1 6 0 1 - 0 Q <br /> L! J <br /> Perms t No. : C - 8 1 - 0 1 7 <br /> This box to be filled in by the Division: <br /> Type of Revision: r1 R(PR, TR, or MR) <br /> Revision Number 2 2 (Sequential by Revision Type) l � � <br /> Revision Submittal Date '-\'• /j/6`l(Date Received by Division) <br /> Revision Completeness Date Revision Incompleteness Date <br /> Revision Adequacy Due Date —/ / Revision Adequacy Date <br /> Revision Decision Due Date /i�,/�`" Fee $0.00 <br /> Brief Description of Revision: 0 -Y- -Z -g _Tj- _L N T) -Y -D R <br /> S I T E — D R A I N _& 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 />