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III IIIIIIIIIIIII III <br />999 <br />STATE OF COLORADO <br />MINED LAND RECLAMATION DIVISION <br />Department of Natural Resources <br />t3t3 Sherman St., Room 2t5 <br />Denver, CO 80203 <br />303 866-3567 <br />Fax: 303 832-Bt06 <br />OF ~~[p <br />aQ'~9 <br />Ne ~ '~ <br />:Rlf <br />~ rB'!e ~ <br />Roy Romer, <br />Governor <br />' Fred R. Barra, <br />APPLICATION FORM FOR A REVISION Onr~sion OlreCtor <br />TO A COAL MINING AND RECLAMATION PERMIT <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 Rule 2.08.4. Three (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 OSht in Denver for Federal mines and for <br />non-Federal mines 1 copy mist 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 - $ ( - Q 2 O ' 2~ ~ ~/ <br />Date: O 6/ O I/ 9 Z ~~~" ~~ <br />Permittee: .5 g ~Z - ~ ~ ,E E K - - - - - ~ UN ~ 1992 <br />street: ~Qk.1Z~.--e ~ ----~ec~maeo~/aina. <br />--- ---------- ~„'n <br />city: ~O Lti14-- --------- <br />State: C O Zip Code: ~ l SZ 4- a Q Z O <br />Mine Name: (~~[~~3Fc~-~~ 1,~.d(-------~ <br />Brief Description of Revision: (~ ~ ~L ~ - ~ ~ ~ ~ - /yL ~ - <br />a~ _~1aet_zL~~__-- <br />~~s~'Q~.---------- <br />Public Notice Attached -Yes ~ No ~ (Required for PR's and TR's) <br />Bond Increase: Yes No X Federal ~ Non-Federal Mine <br />Proposed Change in: <br />Disturbed Area (+/-) <br />Permit Area (+/-) <br />State Land (+/-) <br />- - Q.- Acres <br />_ _ (''._ Acres <br />_ - ~ Acres <br />Affected Area <br />Federal Land <br />Private Land <br />(+/-) - -Q.- Acres <br />(+/-) - _ vi Acres <br />{+/_) - - ~ Acres <br />6185E (10/90) <br />