REV101676

• Permit No: C1980007
• IBM Index Class Name: Revision
• Doc Name: APPLICATION FORM FOR A REVISION TO A COAL MINING AND RECLAMATION PERMIT
• Type & Sequence: MR88
• Media Type: D
• Archive: No

III IIIIIIIIIIIII III
999
STATE OF COLORADO
DIVISION OF MINERALS AND GEOLOGY
Department of Natural Resources
1373 Sherman Sl., Room 215
Denver, CO 80203
Phone: [phone]
FAX:[phone]
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APPLICATION FORM FOR A REVISION Ruy Romer
TO A COAL MINING AND RECLAMATION PERMIT c'°°e"'°`
n+ichael B. Long
Divuron D~rruor
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(136) and permit revisions, as defined in Rule 1.04(90). All
revisions are to address the requirements of Rule 2.08.4. Three (3) 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, the Federal operation is responsible for providing one copy to each
of the agencies noted on the Federal Agencies Mailing List. For non-Federal
mines, the operation is responsible for providing one copy to OSM in
Albuquerque (625 Silver Avenue, SW, Suite 310, New Mexico 87102). The
revision may not proceed until OSM has been provided copies. Copies should be
sent certified mail.
Permit No.: C - d U - _~ y
Date: D H/ _Z Z/ `/ ~
Permittee: ~/Y( 0 G! G7 ~ a i G7 _ ~ U cJ ~ _ _
C ~~- - --- - - - --
Street: ~.~._ ~ D X _~ l l _____
- - - - - - - - - - - - - - -
Ci ty: ~ ~ L 2 /' ~ E
- - - - - - - - - - - - - -
State: C ~_ Zip Code: ~ / ~ ~ ~ - _ _ _ _
Mine Name: {1/ ,Q S ~ ~ I k- `u / h ~
- - - - - - - - - - - - - - - - - - - -
Brief Description of Revision: ,~ ~ ~/ / ,~ Z ~ _ N C D t S _
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Public Notice Attached - Yes No ~ (Required for PR's and TR's)
Bond Increase: Yes No ~ Federal X Non-Federal Mine
Proposed Change in:
Disturbed Area (+/-) Acres
Permit Area (+/-) Acres
State Land (+/-) Acres
Affected Area (+/-) Acres
Federal Land (+/-) Acres
Private Land (+/-)
Acres
6185E (01/93)