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iiiiiniiiiiiiiiiii STATE OF COLO~~v DIVISION Of MINERALS AND GEOLOGY Oepanmem of Nawral Resources 7 717 Sherman Sr.. Room 215 R E C E I V E DenKr. caionea eoza7 Phone: (7071866.7567 FAX: U071872.8I06 APPLICATION FORM FOR A REVISION TO A COAL MINING AND RECLAMATION PERQCI~ O 2 ~~ QIVISIUN OF MINERALS & GEO~~ This form must be completed and submitted with all requests for minor revisions, as defined in Rule 1.04(731, technical revisions, as defined in Rule 1.04(361, and permit revisions, as defined in Rule 1.04(901. All revisions are to address the requirements of Rule 2.08.4. Three (31 copies of the revision, including maps, must be submitted in order for it to be complete. Ror Ronlr Garernor pme 5. lnchhrad 6ennne Oinct« Mla,ad s. Lor,s All revisions are to be formatted so they can be inserted into the permit to replace the revised sections, maps, tables and/or figures, with a revised table of contents, if necessary. The revision submittal date should be printed in the Tower right comer of each revision page. A cover letter to the revision should explain the nature of the revision and reference the specific permit sections being revised. For federal mines, a copy of the revision application must be submitted to all agencies on the federal mailing list at the same time the application is submitted to the Division, and proof of distribution must be submitted to the Division along with the application. Copies of revision pages modified during the review process must be distributed in the same manner, along with proof of disttibution. Proof of distribution must be submitted prior to implementation of the revision. For non-federal mines, a copy of the application for which the Division has issued a proposed approval decision must be submitted to the OSM Albuquerque Field Office (AFOI, and proof of submittal to AFO must be submitted to the Division prior to implementation of the revision. Permit No.: C- 8 0 0 0 7 Date: 1 0/ 0 1 / 9 6 Pertnittee: asnuxxAZrf. r• n e ~c QId.P 9.Dllt - - - - - - - - ~ST ELK MINE - _-------- City: SOMERSET State: C 0 Zip Code: 81 4 3 4- - - - - - _ - Brief Description of Revision: BATHHOUSE ADDITION - - - - - - - Public Notice Attached: Yes _ No ~ (Required for PRs and TRsI Bond Increase: Yes x No Federal x Non-Federal Mine Proposed Change in: Disturbed Area (+/-) - - ~ . 4. Acres Permit Area (+/-) - - 0 . 0 Acres State Land (+/-) - - ~.. Q Acres Affected Area (+/-) - - O O Acres Federal Land (+!-1 - - ~ 0 Acres Private Land (+/-) - - 0 . 0 Acres m:\w d\ah arslfarms\8885