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,• <br />• • iiiiiuiiiiiiiuiii <br />STATE OF COLO./ ~9~ <br />Roy Romer, Governor <br />a; <br />DEPARTMENT OF NATURAL RESOURCES <br />MINED LAND RECLAMATION DIVISION <br />FRED R. BANTA, Director APPLICATION FORM FORA REVISION <br />TO A COAL MINING AND RECLAMATION PERMIT <br />This form must be completed and submitted with all requests for minor revisions, as defined <br />in Rule 1.04(73), technical revisions as defined in Rule 1.04(36) and permit revisions, as <br />defined in Rule 1.04(90). All revisions are to address the requirements of Rule 2.08.4. <br />Three copies of 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 replace the <br />revised sections, maps, tables and/or figures, Explain in the revision what section is being <br />revised. The revision date should be printed in the lower right corner of the revision <br />pages. If necessary, the Table of Contents should also be revised. When the final version <br />of the revision is approved, 7 copies must be sent to OSM in Denver for Federal mines and for <br />non-Federal mines 1 copy must be sent to OSM at 625 Silver Avenue, SW, Suite 310, <br />Albuquerque, New Mexico 87102, The revision may not proceed until OSM has been provided <br />copies. Copies should be sent certified mail. <br />Date: 0 (, / 12 / 9 0 <br />Permittee: r ~, e ~~;,„H !.rnc. <br />1---~P-~--=5------ <br />--------------- 6/'~ <br />Street: .~d SOX 157 ______ ~-u~ <br />- - - - - - - - - - - - - - - <br />c;ty: Cr u~ <br />5----------------- <br />State: ( o Zip Code: $ ) ( ? 6_ - _ _ _ _ <br />Permit No.: C- g l - D 1 D - <br />- -- --- <br />Mine Name: LYsr;2~Jl_._;A!Jir~------____-- <br />Ims oox to oe r111ea 1n oy the u1v1s1on: . ,. <br />Type of Revision: ~ {2 (PR, TR, or MR ) i `~ • - <br /> <br />Revision Number:(Sequential by Revision Type) - ~ '' ~' <br />Rev. Submittal Date: p ~ / / L / 5 G_ (Date Received by Division) <br />Rev. Completeness Date: ~ (/ / 2 / 4 o Rev. Incompleteness Date: _ ~,L _ <br />Rev. Adequacy Due Date: ~ (7 / z Z/ 9 D Rev. Adequacy Date: _ _/_ _/_ <br />Rev. Decision Due Date: D ~/ 2 2 / 9 U Lead Reclamation Specialist: Q ~~ <br />~ans~;, <br />ttrler uescrlpnon or Itevlslon: =tea; r __ ex~,.~u" <br />r <br />Pub1 i c hloti ce Attached - Yes - ~1o X (~qu1 r~ ~r~R s and~tR s ) <br />Bond Increase: Yes No ~ ~e3eral Non-Federal Mine <br />Proposed Change in: <br />Disturbed Area (+/-) 0. Acres Affected Area (+/-) p . Acres <br />Permit Area (+/-) - - p,- Acres Federal Land (+/-) - - ~ - Acres <br />State Land (+/_) - _ ~ - Acres Private Land (+/-) _ _ ~ Acres <br />6185E (Rev, 10/88) <br />215 Centennial Building, 1313 Sherman Street Denver, Colorado 80203-2273 Tel. (303) 866-3567 <br />