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of cow <br />yc� X90 <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 <br />the requirements of Rule 2.08.4. Three (3) copies of the revision, including maps, must be submitted in order for it to <br />be complete. <br />All revisions are to be formatted so they can be inserted into the permit to replace the revised sections, maps, tables <br />and/or figures, with a revised table of contents, if necessary. The revision submittal date should be printed in the lower <br />right corner of each revision page. A cover letter to the revision should explain the nature of the revision and reference <br />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 submitted <br />to the Division along with the application. Copies of revision pages modified during the review process must be <br />distributed in the same manner, along with proof of distribution. Proof of distribution must be submitted prior to <br />implementation of the revision. <br />Permit No.: C-1992-081 Date: July 8, 2016 <br />Permittee: Hayden Gulch Terminal, LLC <br />Street: 29515 RCR27 <br />City: Oak Creek <br />State: Colorado Zip Code: 80477 <br />Brief Description of Revision: Change in Permit Document Location (MR16-26) <br />Public Notice Attached: Yes _ No X (Required for PRs and TRs) <br />Bond Increase: Yes No X Federal X Non -Federal <br />Mine <br />Proposed Change in: <br />Permit Area - <br />Disturbed (+/-) 0.0 Acres <br />Permit (+/-) 0.0 Acres <br />Affected (+/-) 0.0 Acres <br />Surface Ownership - Mineral Ownership - <br />Surface Private (+/-) 0.0 Acres Mineral Private (+/-) <br />0.0 Acres <br />Surface Federal (+/-) 0.0 Acres Mineral Federal (+/-) <br />0.0 Acres <br />Surface State (+/-) 0.0 Acres Mineral State (+/-) <br />0.0 Acres <br />