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COLORADO DIVISION OF RECLAMATION, MINING AND SAFETY <br />'. 1313 Sherman Street, Room 215, Denver, Colorado 80203, (303) 866 -3567 <br />NOV I c IM4 <br />APPLICATION FORM FOR A REVISION <br />TO A COAL MINING AND RECLAMATION PERMIT bMSION Cr RFDLAMATJON <br />MINING 94D Skis ( <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 - 2010 _ 089 Date: 11 /17 /2014 <br />Permittee: Western Fuels- Colorado, A Limited Liability Company <br />Street: 12050 North Pecos Street, Suite 100 <br />City: <br />Westminster <br />State: CO Zip Code: 80234 _ <br />Brief Description of Revision: Appendix 2.05.3(2) -2 incorporates the construction <br />certification for the SE Haul Road into the PAP. <br />Public Notice Attached: Yes®✓ <br />No [](Required for PRs and TRs) <br />Bond Increase: Yes[] No®✓ <br />Federal ® Non - Federal ® Mine <br />Proposed Change in: <br />Permit Area - <br />Surface Ownership - <br />Disturbed ( + / -)0_0 _ _ <br />_ Acres Private Land ( + / -) 0.0 _ _ —Acres <br />Permit ( + / -)0_0 _ _ . <br />—Acres Federal Land ( + / -) 0.0 _ _ —Acres <br />Affected ( +/ -)0.0 _ _ . <br />—Acres State Land ( + / -) 0.0 _ _ _ Acres <br />Mineral Ownership - <br />0.0_ <br />Mineral Private ( + / -) <br />_ _Acres Mineral State (+/-)0.0 _ _ —Acres <br />Mineral Federal ( + / -) 2-0_ <br />_ _ Acres <br />