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�,� ° COLORADO DIVISION OF MINERALS AND GEOLOGY <br />'.* ,8,6 • 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), <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 - 019 Date: 03 / 27 / 17 <br />Permittee: Colowyo Coal Company, L.P. <br />RECEV <br />Street: 5731 State Highway 13 <br />' of Recta afion, <br />City: Meeker iviston, fety <br />State: Co Zip Code: 81641 _ <br />Brief Description of Revision: MR -171 revised topsoil windrow locations <br />at the temporary Jubb Creek facilities area. <br />Public Notice Attached: Yes __ No ✓ (Required for PRs and TRs) <br />Bond Increase: Yes No ✓ <br />Federal ✓ <br />Non -Federal <br />Mine <br />Proposed Change in: <br />Permit Area - <br />Surface Ownership - <br />Disturbed (+/-) _ _ 0 <br />.0 Acres <br />Private Land <br />(+/-) _ <br />_ 0 . 0 <br />Acres <br />Permit (+/-) _ _ 0 <br />.0 Acres <br />Federal Land <br />(+/-) _ <br />_ 0 . 0 <br />Acres <br />Affected (+/-) _ _ 0 <br />. 0 Acres <br />State Land <br />(+/-) _ <br />_ 0 0 <br />Acres <br />Mineral Ownership - <br />Mineral Private (+/-) _ _ <br />0 0 Acres <br />Mineral State <br />(+/-) _ <br />—0 0 <br />Acres <br />Mineral Federal (+/-) _ _ <br />0. 0 Acres <br />