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III IIIIIIIIIIIIIIII ~ <br />999 <br />`'~~ STATE OF COLORADO <br />~ MINED LAND RECLAMATION DIVISION <br />pF COCO <br />I~~ Department of Natural Resources N~~'~> <br />~k ~ . 1373 Sherman St„ Room 215 ~ n 1g <br />F~ Denver, CO 60203 ~ <br />F 303 666-3567 /A ]6' <br />Fn X: 303 832-8106 <br />Roy Romar. <br />Governor <br />Fretl R. Banta. <br />APPLICATION FORM FOR A REVISION orvision Girector <br />}} TO A COAL MINING AND RECLAMATION PERMIT <br />F;:_, ;: <br />This form must be completed and submitted with all requests for minor <br />revisions, as defined in Rule 1.04(73), technical revisions as defined in <br />Rule 1.04(36) and permit revisions, as defined in Rule 1.04(90). All <br />revisions are to address the requirements of Ru le 2.08.4. firee (3) copies of <br />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 <br />replace the revised sections, maps, tables and/or figures. Explain in the <br />revision what section is being revised. The revision date should be printed <br />in the lower right corner of the revision pages. If necessary, the Table of <br />Contents should also be revised. When the final version of the revision is <br />approved, 7 copies must be sent to OSM in Denver for Federal mines and for <br />non-Federal mines i copy must be sent to OSM at 625 Silver Avenue, SW, Suite <br />310, Albuquerque, New Mexico 87102. The revision may not proceed until OSM <br />has been provided copies. Copies should be sent certified mail. <br />Permit No.: C - ~ L - Q 2 ~ <br />Date: % ~i / 1 g./ Q L ~-~I~~~e v ~~;,' <br />Permittee: ,~~4C-~Q,[LL ~'Q----- <br />----- -------- OCT181991 <br />Street: 1~2QQ~./E~.~gg.rC~f .~E <br />Mined Land <br />~ ~ 2 ° - - - - - - - - - - - Reclamation Division <br />- city: ~E~E~ZB1.1~CE.---------- <br />State: ~ Q Zip Code: $ Q Q.~ ~ - - - - - <br />MineName: /S'~~~~o~,/~~c~----------- <br />Brief Description of Revision: ~~t ~Lp~ E~ ~ ~ -~~~/~! 7-~ <br />.~LaLCz-.~F~! ~.~-EQB-. <br />.L~.B.1f.'t~BLY.€/3-~Qtio- <br />Public Notice Attached - Yes ~ No ~ (Required for PR's and 7R's) <br />Bond Increase: Yes ~ No ~ Federal Non-Federal 1~ Mine <br />Proposed Change in: <br />Disturbed Area (+/_) Q - - - Acres Affected Area (+/_) O - - - Acres <br />Permit Area (+/_) p - - - Acres Federal Land (+/_) ~ _ _ Acres <br />State Land (+/_) O - - Acres Private Land (+/-) ~ _ _ Acres <br />6185E (10/90) <br />