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�A t (L: <br />COLORADO DIVISION OF RECLAMATION, MINING AND SAFETY <br />,A e 1313 Sherman Street, Room 215, Denver, Colorado 80203, (303) 866 -3567 <br />��A tv <br />6R <br />APPLICATION FORM FOR A REVISION DEc I vv3 <br />TO A COAL MINING AND RECLAMATION PERMIT OMSION OF RECLAMATION <br />tr1 NG AND SAFETY <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 - 92 - 81 Date: 12 / 5 / 2013 <br />Permittee: Hayden Gulch Terminal, LLC <br />Hayden Gulch Loadout <br />Street: 37796 RD 53 PO Box 670 <br />City: Hayden <br />State: CO Zip Code: 81639 _ 0670 <br />Brief Description of Revision: MR 23; Update for Tab 3 Attachment 3 -2; Owner, <br />Officer and Director Information. Please replace the <br />Public Notice Attached: Yes❑ No ❑✓ (Required for PRs and TRs) <br />Bond Increase: Yes❑ No❑ Federal ❑ Non - Federal ❑✓ Mine <br />Proposed Change in: <br />Permit Area - Surface Ownership - <br />Disturbed ( +/ -)0 _ _ —Acres Private Land ( + / -) 0 _ _ _ Acres <br />Permit ( + / -)0 _ _ —Acres Federal Land ( + / -) 0 _ _ _ Acres <br />Affected ( + / -)0 _ _ _Acres State Land (+/-)o _ _ —Acres <br />Mineral Ownership - <br />Mineral Private ( + / -) 0 _ _ _Acres Mineral State (+/-)o _ _ —Acres <br />Mineral Federal ( + / -) 0 _ _ _ Acres <br />