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Proposed Change in: <br />Disturbed Permit Area - _`` <br />( +/ -) — N — Acres <br />(+0_ 4/4- <br />Affected ( +1 -) — b ilk: -_ Acres <br />Public Notice Attached: Yes® No <br />Bond Increase: Yes❑ No® <br />Permit <br />COLORADO DIVISION OF RECLAMATION, MINING AND SAFETY <br />1313 Sherman Street, Room 215, Denver, Colorado 80203, (303) 866 -3567 <br />ReGEi <br />Mineral Ownership - <br />Mineral Private ( +1 -) — 4 -t _Acres <br />Mineral Federal ( + / -) — Acres <br />APPLICATION FORM FOR A REVISION <br />TO A COAL MINING AND RECLAMATION PERM • n of Resate on, <br />VON <br />This form must be completed and submitted with all requests for minor revisions, as defined in Rule 1.04(73), <br />technical revisions, as defined in Rule 1.04(136), and permit revisions, as defined in Rule 1.04(90). All revisions <br />are to address the requirements of Rule 2.08.4. Three (3) copies of the revision, including maps, must be <br />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 revised sections, maps, <br />tables and /or figures, with a revised table of contents, if necessary. The revision submittal date should be printed <br />in the lower right corner of each revision page. A cover letter to the revision should explain the nature of the <br />revision and reference the specific permit sections being revised. <br />For federal mines, a copy of the revision application must be submitted to all agencies on the federal mailing list <br />(except OSM) at the same time the application is submitted to the Division, and proof of distribution must be <br />submitted to the Division along with the application. Copies of revision pages modified during the review process <br />must be distributed in the same manner, along with proof of distribution. Proof of distribution must be submitted <br />prior to implementation of the revision. <br />Permit No.: C - 'W j \0 - - D €jam') Date: Q9_ . <br />/ 1 / � 2. <br />1 <br />Permittee: \4 5'T� 1211 cdtc..f- / - ltW tz -&-Do <br />Street: 12 <br />S Jr 100 <br />City: \4t kM t t.\ <br />State: L Zip Code: 4,02 - <br />Brief Description of Revision: St3Mt'k+n -v 0� 1�1�t -tdw . D'tZb Z <br />ot4 C,014iDt - _ La- ePt .t,A►t - -69 <br />k op5OkL., 6k-sz-liA=N <br />1 <br />Acres <br />(Required for PRs and TRs) <br />Federal ❑ Non - Federal <br />Surface Ownership - <br />Private Land ( + / -) — <br />( +1 -) — <br />( +1 -) — <br />Federal Land <br />State Land <br />Mineral State (+/-)___ <br />� 2920 <br />Mine <br />/A—,_ Acres <br />1,191,-___ Acres <br />Acres <br />Acres <br />