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COLORADO DIVISION OF MINERALS AND GEOLOGY <br />*•8;6"y 1313 Sherman Street, Room 215, Denver, Colorado 80203, (303) 866 -3567 <br />APPLICATION FORM FOR A 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 in Rule 1.04(73), <br />technical revisions, as defined in Rule 1.04(136), and permit revisions, as defined in Rule 1.04(90). All revisions <br />are to address the requirements of Rule 2.08.4. Three (3) copies of the revision, including maps, must be <br />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 revised sections, maps, <br />tables and /or figures, with a revised table of contents, if necessary. The revision submittal date should be printed <br />in the lower right corner of each revision page. A cover letter to the revision should explain the nature of the <br />revision and reference the specific permit sections being revised. <br />For federal mines, a copy of the revision application must be submitted to all agencies on the federal mailing list <br />(except OSM) at the same time the application is submitted to the Division, and proof of distribution must be <br />submitted to the Division along with the application. Copies of revision pages modified during the review process <br />must be distributed in the same manner, along with proof of distribution. Proof of distribution must be submitted <br />prior to implementation of the revision. <br />Permit No.: C - 1981 - 018 Date: <br />Permittee: Blue Mountain Energy, Inc. <br />Street: <br />City: <br />State: <br />3607 CR 65 <br />11 / 18 / 2013 <br />REeEINIE'D <br />o 'L 12013 <br />9 Y <br />CO el � 81648 _ bIVS�NING��S��o <br />Zip Code. M <br />Brief Description of Revision: Relocate return shaft (RS -11 Q and drill holes <br />with reductions in associated roads and conversion <br />of one segment of exploration road to the mining <br />permit. <br />Public Notice Attached: Yes <br />No ✓ . (Required for PRs and TRs) <br />Bond Increase: Yes ✓ No <br />Federal ( <br />Non - Federal Mine <br />Proposed Change in: <br />Permit Area - (Reduction) <br />Surface Ownership <br />p - <br />Disturbed ( +/ -) _ _ -0 <br />52Acres <br />Private Land ( + / -) _ _ <br />_ —Acres <br />Permit ( +/ -) _ _ 0 . <br />I Acres <br />Federal Land ( + / -) _ _ <br />_ —Acres <br />Affected ( +/ -) _ _ 0. <br />0 Acres <br />State Land ( + / -) _ _ <br />_ —Acres <br />Mineral Ownership - <br />Mineral Private ( + / -) _ _ <br />_ _Acres <br />Mineral State ( + / -) _ _ <br />_ —Acres <br />Mineral Federal ( + / -) _ _ <br />_ —Acres <br />