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oF.�O<o <br />OLORADO DIVISION OF RECLAMATION, MINING AND SAFETY <br />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), technical <br />revisions, as defined in Rule 1.04(136), and permit revisions, as defined in Rule 1.04(90). All revisions are to address the <br />requirements of Rule 2.08.4. Three (3) copies of the revision, including maps, must be submitted in order for it to be <br />complete. <br />All revisions are to be formatted so they can be inserted into the permit to replace the revised sections, maps, tables and/or <br />figures, with a revised table of contents, if necessary. The revision submittal date should be printed in the lower right corner of <br />each revision page. A cover letter to the revision should explain the nature of the revision and reference the specific permit <br />sections being revised. <br />For federal mines, a copy of the revision application must be submitted to all agencies on the federal mailing list (except OS1V1) <br />at the same time the application is submitted to the Division, and proof of distribution must be submitted to the Division along <br />with the application. Copies of revision pages modified during the review process must be distributed in the same manner, <br />along with proof of distribution. Proof of distribution must be submitted prior to implementation of the revision. <br />Permit No.: C -81 -044 <br />Permittee: Moffat County Mining, LLC <br />Street: <br />29515 RCR27 <br />City: <br />Oak Creek <br />State: <br />Colorado Zip Code: 80477 <br />Date: March 10, 2015 <br />RECEIVED <br />MAR 13 2015 <br />Brief Description of Revision: Peabody Officer and Director Update (MR15 -52) Division of Reclamation, <br />Public Notice Attached: Yes— No X (Required for PRs and TRs) <br />Whiny &Safety <br />Bond Increase: <br />Yes <br />No X <br />Proposed Change in: <br />Permit Area - <br />Disturbed <br />( + / -) <br />0.0 Acres <br />Permit <br />( + / -) <br />0.0 Acres <br />Affected <br />( + / -) <br />0.0 Acres <br />Surface Ownership - <br />Surface Private ( + / -) 0.0 Acres <br />Surface Federal <br />( + / -) 0.0 Acres <br />Federal X Non- Federal Mine <br />Mineral Ownership - <br />Mineral Private ( + / -) 0.0 Acres <br />Mineral Federal <br />Surface State ( + / -) 0.0 Acres Mineral State <br />( + / -) 0.0 Acres <br />( + / -) 0.0 Acres <br />