2016-06-07_REVISION - C1982056 (6)

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�p C.d z7 tllfa�G �p COLORADO DIVISION OF R.ECLAMATI©N, MINING, AND SAFETY 1313 Sherman Street, Room 215, Denver, Colorado 80203, (303) 866-3567 APPLICATION FORM FOR A REVISION TO A COAL MINING AND RECLAMATION PERMIT 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 the 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 titre permit to replace the revised sections, snaps, tables and/or figures, with a revised table of contents, if necessary. The revision submittal date should be printed in the lower right corner of each revision page. A cover letter to the revision should explain the nature of the revision and reference the specific pennit sections being revised. For federal mines, a copy of the revision application must be submitted to all agencies on the federal mailing list (except OSM) at the sante time the application is submitted to the Division, and proof of distribution must be submitted to the Division along with the application. Copies of revision pages modified during t11e review process must be distributed in the sante planner, along with proof of distribution. Proof of distribution must be submitted prior to implementation of the revision. Permit No.: C-82-056 Permittee: Tiwentymile Coal, LLC Street: 29515 Routt County Road 27 City: Qat. Creek State: Colorado Zip Code: 80467 Date: June 2, 2016 Brief Description of Revision: Fish Creek Borehole Flocculant System (MR16-298) Public Notice Attached: Yes No X (Requiredfor PRs and TRs) Bond Increase: Yes No X Federal X Non -Federal Mine Proposed Change in: Permit Area Disturbed 0.0 Acres Perillit 0.0 Acres A Efected 0.0 Acres Surface Ownership Mineral Ownership Private Land 0.0 Acres Private Land 0.0 Acres Federal Land 0.0 Acres Federal Land 0.0 Acres State Land 0.0 Acres State Land 0.0 Acres