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V Y <br /> Fe <br /> STATE OF COLORADO <br /> * * Roy Romer, Governor <br /> *1876 (6� <br /> nO <br /> DEPARTMENT OF NATURAL RESOURCES W <br /> MINED LAND RECLAMATION DIVISION <br /> FRED A. BANTA, Director <br /> 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 pr ided <br /> copies. Copies should be sent certified mail . <br /> Date: 0 J / I q 18 `? <br /> Permittee: Lb = -7 <br /> Street: �� - - - - - - - - <br /> - — — — — — — — — — — — — — - <br /> City: L - - - - - - - - - - <br /> State: Zip Code: — <br /> Permit No.: CThis box to be filled in by the Division: <br /> Type of Revision: ` \ (K (PR, TR, or MR) <br /> Revision Number ' a (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 /g e Fee $0.00 <br /> Brief Description of Revision: I T H �— E <br /> x- C o -7 -7— <br /> Public Notice Attached - Yes ;0L_),7(FequIreU Tor- sand-'RT) <br /> Bond Increase: Yes No X —ederal �— Non-Federal Mine <br /> Proposed Change in: <br /> Disturbed Area (+/-) �._ Acres Affected Area Acres <br /> Permit Area Acres Federal Land (+/-) —� — — Acres <br /> State Land (+/-) — — T <br /> _ Acres Private Land (+/-) — — Acres <br /> Lead Reclamation SpecTa-lTst LW -L 6185F (Fev. 2798) <br /> 423 Centennial Building, 1313 Sherman Street Denver, Colorado 80203-2273 Tel. (303) 866-3567 <br />