REV89198

• Permit No: C1983059
• IBM Index Class Name: Revision
• Doc Date: 6/5/1990
• Doc Name: APPLICATION FORM
• Type & Sequence: MR5
• Media Type: D
• Archive: No

III IIIIIIIIIIIIIIII
999 STATE OF COLORADO
Roy Romer, Governor ~
DEPARTMENT OF NATURAL RESOURCES
MINED LAND RECLAMATION DIVISION
FRED R. BANTA, Director APPLICATION FORM FORA REVISION
TO A COAL MINING AND RECLAMATION PERMIT
This form must be completed and submitted with all requests for minor revisions, as defined
in Rule 1.04(73), technical revisions as defined in Rule 1.04(36) and permit revisions, as
defined in Rute 1.04(90). All revisions are to address the requirements of Rule 2.08.4.
Three copies of your revision including maps must be submitted in order for it to be complete.
All revisions are to be formatted so they can be inserted into the permit to replace the
revised sections, maps, tables and/or figures. Explain in the revision what section is being
revised. The revision date should be printed in the lower right corner of the revision
pages. If necessary, the Table of Contents should also be revised. When the final version
of the revision is approved, 7 copies must be sent to OSM in Denver for Federal mines and for
non-Federal mines 1 copy must be sent to OSM at 625 Silver Avenue, SW, Suite 310,
Albuquerque, New Mexico 87102. The revision may not proceed until OSM has been provided
copies. Copies should be sent certified mail.
Date: ~ b / o $'/ ~ r3
- - - - - - - - - - - - - - -
~'. 3 N• /~
- - - - - - - - - - - - - - -
.s
- - - - - - - - - - - - - - -
- - - - - - - - - - - - - - -
State: ~ sa Zip Code: / 2. ~ -
Permit No.: C - $s'' ti - ~ S ~ <; /
Mine Name: ~ ~ ~~ ~ a ~1,_ .~ ~• ~'~ ~ :~ - ~. ~ ~ ~' ~ °`-~
1s ox to e i e 1n y ne 1v1s1on: I
~ lei
Type of Re vision: /Yj ,ft'. (PR, TR, or MR )
Revision Number: ~ ~ (Sequential by Revision Type) ~/ ~~ v ~ ~'~~ 9~
Rev. Submittal Date: ~ ~/ C "/ / ~ ~ (Date Received by Division)
Rev. Completeness Date: O Q/6 l / g _OvRev. Incompleteness Date: _~ G/ / S'/_~ ~'
Rev. Adequacy Due Date: 0 8/ t 3/ ~' o 'Rev. Adequacy Date: _ _/_ _/_ _
Rev. Decision Due Date: O Fr/1 ~ /~ v ~ead Reclamation Specialist: _ _
rte escrip ion o evlslon: !r;. ~. ~:; ~ ~ E? T' E'. ,~ t. A?
Public hlotice Attached - Yes -fJo (}2equi rem 1•or~R s and TR s )
Bond Increase: Yes No T Federal Non-Federal ~ Mine
Proposed Change in:
Disturbed Area (+/_) _,~ Acres Affected Area (+/-) _ _ ~ Acres
Permit Area (+/-) _ - A Acres Federal Land (+/-) _ - - Acres
State Land (+/-) -_ -_ -_ - Acres Private Land (+/-) _ -_ -_ Acres
6185E (Rev. 10/88)
215 Centennial Building, 1313 Sherman Street Denver, Colorado 80203.2273 Tel. [phone]
r V~/ T '