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r,.)$ COLORADO DIVISION OF RECLAMATION, MINING AND SAFETY <br />'`"r`" 1313 Sherman Street, Room 215, Denver, Colorado 80203, (303) 866-3567 <br />♦ B76 � <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 - 008 Date: 07 /_05 /2016 <br />Permittee: Elk Ridge Mining and Reclamation, LLC <br />Street: 27646 West 5th Street <br />P.O. Box 628 <br />City: Nucla <br />State: CO Zip Code: 81424 _ <br />Brief Description of Revision: TR -74 requests an extension to the 180 day backfill <br />requirement and proposes backfill monitoring wells. <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 _ _ . —Acres <br />Federal Land (+/-) 0_0 _ _ , —Acres <br />Affected (+/-)0.0— —.—Acres <br />State Land (+/-) 0.0 _ _ _ Acres <br />Mineral Ownership - <br />0.0_ <br />0_0 <br />Mineral Private (+/-) <br />_ _Acres Mineral State (+/-) _ _ —Acres <br />Mineral Federal (+/-) 0.0_ <br />— . —Acres <br />