REV97696

• Permit No: C1981013
• IBM Index Class Name: Revision
• Doc Date: 7/6/1992
• Doc Name: APPLICATION FORM FOR A REVISION TO A COAL MINING AND RECLAMATION PERMIT
• Type & Sequence: TR19
• Media Type: D
• Archive: No

III IIIIIIIIIIIII III
999
STATE OF COLORADO
~_ Ray Ramer. Governor ~~,
• gets'
~_~ • `;.
DEPARTMENT OF NATURAL RESOURCES '~ ~~
MINED LAND RECLAMATION DIVISION ~~
.;.
FRED R. BAN7A, Dlreetor AppLICATION FORH FORA REVISION -~Lj'~ "~ ~~
TO A COAL MINING AND RECLAMATION PERMIT ~~ ~~
This form must be completed and submitted xith ali 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 Rule 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 Sec Lions, 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. 'dhen the fi^al version
of the revision is approved, 7 copies must be sent to 0514 in Denver for Federal mines and `or
non-Federal mines 1 copy must be sent to OSM at 625 Silver Avenue, SW, Suite 310,
Albuquerque, New t•lexico 87102. The revision may not proceed until OSM has been provided
copies. Copies should be sent certified mail.
Date: ~ ~/ ~ Z/ ~. Z
Perini ttee: ~( ~ ~ ~ ~ ~ ~ - ~ ~ ~ L - ~ Q

c;ty: ---------=----- ~EC~lif~~
State: ~ Q Zip Code: ~ L 2 ~ 1 - - - - - ~ U L U 6 1992
permit Ho.: C - ~- ~.. - ~ L .~
14i ne Name: (~ Q `. ~ ~ ~/ - ~ ~ (~ ~ ~- - - Mlned Lend
- ~-~~
1s oox to oe tlllea 1n oy the u1 v1 s1 on:
Type of Revision: _~ (PR, TR, or MR)
Revision plumber: ~ ~ (Sequential by Revision Type)
Rev, Submittal Date: _
Rev, Completeness Date:
Rev. Adequacy Due Date:
Rev. Decision Due Date:
rte escrlp ton o e
Public Notice Attached
Bond Increase: Yes >(
proposed Change in:
_/_ _/_ _ (Date Received by Division )
_ _/_ _/_ _ Rev, Incompleteness Date: _ _/_ _/
_ _/_ _/_ _ Rev, Adequacy Date: _ /_ _/_ _
_/ _/_ _ Lead Reclamation Specialist:
- Yes %_ Nom ~(Req~red >or~R~s ~d~R~
tlo -Federal Non-Federal Kline
sturbed Area (+/-) Acres Affected Area (+/_) p , Acres
rermit Area (+/-) - -_ - Acres Federal Land (+/_) - - - 'Acres
State Land (+/-) -_ _ _ Acres Private Land (+/_) - - _ Acres
6185E (Rev, 10/88)
215 Centennial Building. 1313 Sherman Street Denver, Coloratlo 80203-2273 Tet. [phone]