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~ -/Of COQ <br />R~ /~ 0~ <br />~e -«ii c'rr 90 <br />H C-~ O <br />i \ ~ ` \ r <br />t ~_ ^' <br />r876 ~ <br />Ricnaro D. Lamm <br />Governor <br />APPLICATION FORM FORA REVISION <br />TO A COAL MINING AND RECLAtdATION PER1dIT <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 P.u1e 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: 11/ ~ ~/ ~ Z <br />Perini ttee: c 0 L~ R A D 0- Y A M P A - <br /> <br />Street: 2 9 5 8 <br />- - - - 8 R O U T T C N T Y <br />- - - - - - - - - - - <br /> R QED -ll ? ~ ------- oEClo~9a~ <br />city: .4~~- ~-g~~~------- -- <br />1b1t}dEB-LAND <br />State: ~ ~ Zi p Code: g. Q ~ ~ L - - - - - RECLAMATION DIVISION <br />Perini t No.: C- g I - 0 7 1 <br />This box to be filled in by the Division: <br />Type of Revision: _ _ (PR, TR, or MR) <br />Revision Number - - (Sequential by Revision Type) <br />Revision Submittal Date -/ /- (Date Received by Division) <br />Pevision Completeness Date -/ / Revision Incompleteness Date -/ / <br />Revision Adequacy Due Date -/_/ Revision Adequacy Date -/ / <br />Revision Decision Due Date <br />Fee S0,00 <br />Brief Description of Revision: ~. Z 2 K~ g -~~ A L- L o A D 0 u T <br />Public Notice Attached - Yes _ No g (Required for PR's and TR's) <br />Bond Increase: Yes _ No ~L <br />Proposed Change in: <br />Disturbed Area (+/-) - - ~. - Acres Affected Area (+/-) - - 0 . - Acres <br />Permit Area (+/-) _ _ p , _ Acres Federal Land (+/-) _ _ 0 Acres <br />State Land (+/-) - - 0 Acres Private Land (+/-) - - 0 Acres <br />Lead Reclamation Specialist 6185E <br />423 Centennial Building, 1313 Sherman Street Denver, Colorado 80203 Tel. (303) 866.3567 <br /> <br />DEPARTMENT OF NATURAL RESOURCES <br />Dana H. Getcnes. Eiecutrve Director <br />MINED LAND RECLAMATION DI\ <br />DAVID C. SHElTO N, Director <br />• III IIIIIIIIIIIIIIII~ <br />999 <br />