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iii iiiiiiiiiiiii iii <br />999 <br />STATE OF COLORf'~DO <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources <br />1313 Sherman 51., Room 21 S <br />Denver, ColoraAo 80207 <br />Phone: 13071 866-3567 <br />FAx: (3031832-8106 APPLICATION FORM FOR A REVISION <br />TO A COAL MINING AND RECLAMATION PERMIT <br />l . <br />~~~ <br />DEPARTMEIV-I C?r. <br />NATURA~~® <br />RESOURCE= <br />This form must be completed and submitted with all requests for minor revisions, as defined in Roy Romer <br />Rule 1.04(731, technical revisions, as defined in Rule 1.041361, and permit revisions, as defined Inver^°r <br />in Rule 1.041901. All revisions are to address the requirements of Rule 2.08.4. Three 131 copies lames s. Lochhead <br />of the revision, including maps, must be submitted in order for it to be complete. E%PCO1Ve °1e1or <br />Michael R. Long <br />Division Dire:eror <br />All revisions are to be formatted so they can be inserted into the permit to replace the revised <br />sections, maps, tables and/or figures, with a revised table of contents, if necessary. The revision <br />submittal date should be printed in the lower right corner of each revision page. A cover letter to the <br />revision should explain the nature of the 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 <br />list at the same time the application is submitted to the Division, and proof of distribution must be submitted <br />to the Division along with the application. Copies of revision pages modified during the review process must <br />be distributed in the same manner, along with proof of distribution. Proof of distribution must be submitted <br />prior to implementation of the revision. For non-federal mines, a copy of the application for which the <br />Division has issued a proposed approval decision must be submitted to the OSM Albuquerque Field Office <br />(AF01, and proof of submittal to AFO must be submitted to the Division prior to implementation of the <br />revision. ~~ n <br />c ~'o( <br />Permit No.: C: - r - ~? ,~ Date: ~ ? / ~ S / g ! <br />Permittee: rft ~o cK ~oIAL own PA+~ <br />- - - - - - - - - - - - - - - <br />Street: L3S~-/ 7~ s-r'+91=~T - su=~ 3S~ <br />- - - - - - - ~€~~IVE~ <br />- - - - - - - - - - - - - - - <br />~;ri; ~~.a~~~,---------JUL271994 <br />State: C O Zip Code: ~4 ~L O ~_ - - _ <br />\ nn ~'visiCiTOrNfiner 1, U <br />Brief Description of Revision: 1~IS ~o,vTtNaAE /9'FGDu xR~ r-t>=~T'c' 7 a'fA~ - <br />1%wlrf Sm~/S ~eRNn~~-.-5 <br />- - - - - - - - - - - - - - <br />- - - - - - - - - - - - - - <br />Public Notice Attached: Yes - No ~- (Required for PRs and TRs1 <br />Bond Increase: Yes - No ~ Federal - Non-Federal J~ Mine <br />Proposed Change in: ~~ <br />Disturbed Area (+/-) - - - -Acres Affected Area (+/-) - - - _ Acres <br />Permit Area (+/-) - - - -Acres Federal Land (+/-) - - - -Acres <br />State Land (+/-) - - - -Acres Private Land (+/-) - - - -Acres <br />m: \rael\s h ere\forms\8865 <br />