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iiiiiiiiiiiniiiiii 999 DEPARTMENT OF NATURAL RESOURCES Dav~tl H. Getcnes. Executive Director MINED LAND RECLAMATION DIVISION DAVID C. SHELTON, Director Richartl D. Lamm G°"°`"°r APPLICATION FORM FOR A 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 Rule 1.04(90). A11 revisions are to address the requirements of Rule 2.08.4. A11 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. Date: o b/ >_ s/ a 9 Permittee: c o L o w x o_ c 2~~_~ 9.. ~•• Street: 5 7 3 1_ S T ~is~_~l~tL~- ~ ,a3~ 11 1 3 ----------- ~~\l L _ City: M E E K E R ________ _____ '' State: C 0 Zip Code: 8 1 6 4 1 Permit No.: C- 8 1- 0 1 9 This box to be filled in by the Division: Type of Revision: _ _ (PR, TR, or MR) Revision Number _ _ (Sequential by Revision Type) Revision Submittal Date _/_/ (Date Received by Division) , Revision Completeness Date _/ / Revision Incompleteness Date _/ / Revision Adequacy Due Date _/ / Revision Adequacy Date _/ / Revision Decision Due Date / / Fee E0.00 Brief Description of Revision: E x P L o R a T r o x____ D R I L L I N G Public Notice Attached - Yes _ No x (Required for PR's and TR's) Bond Increase: Yes _~ No Proposed Change in: Disturbed Area (+/-) _ _ g ,~ Acres Affected Area (+/-) _ _ _ _ Acres Permit Area (+/-) _ _ _ _ Acres Federal Land (+/-) _ _ _ Acres State Land (+/_) Acres Private Land (+/-) Acres Lead Reclamation Specialist Mr. To_y Waldron 6185E 423 Centennial Building, 1313 Sherman Street Denver, Colorado 80203 Tel. (303) 866-3567