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<br />STATE of coo III IIIIIIIIIIIIIIII <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Rewurces <br />1313 Sherman 51., Roam 215 <br />Denver, Colorado 80207 <br />Vhone: 1307) 846~J567 APPLICATION FORM FOR A REVISION <br />FAX: 1307) 8328106 <br />~~ TO A COAL MINING AND RECLAMATION PERMIT <br />This form must be completed and submitted with all requests for minor revisions, as defined in <br />Rule 1.04(731, technical revisions, as defined in Rule 1.0411361, and permit revisions, as defined <br />in Rule 1.04(901. All revisions are to address the requirements of Rule 2.08.4. Threa (31 copies <br />of the revision, including maps, must be submitted in order for it to be complete. <br />Roy Romer <br />(:ovaror _ <br />l,mes s. L«nne,d <br />EaKUlive DirKlar <br />Michael 0. Lops <br />Divirion Dirttra <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 latter 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 tha application is submitted to the Division, and proof of distribution must be submitted <br />to the Division along with the application. Copies of revision papas 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 />(AFOI, and proof of submittal to AFO must be submitted to the Division prior to implementation of the <br />revision. <br />rR1ROiC 2eL.lJ~.(.OR <br />Permit No.: C - ~ - -Q(~ - - Date: ~3- / ~g - / ~ <br />Permittee: ~o~l~egue2- - - - - - - - - - - `i ~ ~. F I V F ~ ~~ <br />_D. _G Corte l7i~te _ _ <br />Street: 2054 Cotucty r2oad 730 - - - - - - - -APR Q'3 1997 <br />- - - - - - - - - - - - - - - <br />Gnnn.i~oa - - - - - - - - - - -pims~on of Minerals +~ ~eoioy; <br />City: - - - - - - - - - - - - - - - <br />State: Co_ Zip Code:B/?3~ - - - - - - - <br />Brief Description of Revision: RorDrimrrf ipa_S'~h,,,~„n„- - _ - - - - - <br />Public Notice Attached: Yes - No - (Required /or PRs and TRs) <br />Bond Increase: Yes - No - Federal - Non-Federal - Mine <br />Proposed Change in: <br />Disturbed Area (+/-1 - _ _ ,Acres <br />Permit Area (+1-1 - - _ _ Acres <br />Stato Land (+/-) - - - -Acres <br />m:\ooel\ch era\I orms\888 6 <br />Affocted Area (+/-1 - _ - <br />Federal Land (+/-) - - - <br />Private Land (+/-1 ._ _ - <br />-Acres <br />-Acres <br />-Acres <br />