2017-08-27_REVISION - C1981012

• Permit No: C1981012
• IBM Index Class Name: Revision
• Doc Date: 8/27/2017
• Doc Name: Modification Application
• From: New Elk Coal Company, LLC
• To: DRMS
• Type & Sequence: TR71
• Email Name: RDZ
• Email Name: JRS
• Media Type: D
• Archive: No

STATE OF COLORADO
DIVISION USE ONLY
WQCD Division Initiated
Modification
Requested by
Date requested
Date entered
MODIFICATION APPLICATION
Please print or type all information. All items must be filled out completely and correctly. If the form is not
complete, it will be returned. All modification dates are established by the Division. This form is for modifying an
established permit or certification. Terminations, Change of Contacts, Transfer of Permit, and Withdrawl of
Permit Application and/or modification requests must be submitted on the appropriate form:
MAIL ORIGINAL FORM WITH INK SIGNATURES TO THE FOLLOWING ADDRESS:
Colorado Dept of Public Health and Environment
Water Quality Control Division
4300 Cherry Creek Dr South WQCD-P-B2
Denver, CO 80246-1530
FAXED or EMAILED FORMS WILL NOT BE ACCEPTED
• PART A. IDENTIFICATION OF PERMIT Please write the permit number to be modified
PERMIT NUMBER CO -0000906
• PART B. PERMITEE INFORMATION (application must be signed by the legal contact listed here)
Company Name New Elk Coal Company LLC
Mailing Address 12250 Highway 12
City
Weston
Legal Contact Name Louis Head
Title President
• PART C. FACILITY/PROJECT INFORMATION
Facility/Project Name New Elk Mine
State CO Zipcode 81091
Phone
Number 719-613-6141
Email [e-mail]
Location (address) 12250 Highway 12
City Weston County Las Animas
Jim Be ano Phone [phone]
Local Contact Name g Number
Title Manager
Email [e-mail]
Page 1 of 2 form last revised December 2011
of �
Dedicated to protecting and improving the health and environment of the people of Colorado
ti4 f+ i
Nq
4300 Cherry Creek Dr. S.
Laboratory Services Division
t '
Denver, Colorado 80246-1530
8100 Lowry Blvd.
a
Phone [phone]
Denver, Colorado 80230-6928
x976'
TDD Line [phone]
[phone]
Colorado Ikpartment
Located in Glendale, Colorado
of Pubbc Heahh
http://www.cdphe.state.co us
and Emironment
DIVISION USE ONLY
WQCD Division Initiated
Modification
Requested by
Date requested
Date entered
MODIFICATION APPLICATION
Please print or type all information. All items must be filled out completely and correctly. If the form is not
complete, it will be returned. All modification dates are established by the Division. This form is for modifying an
established permit or certification. Terminations, Change of Contacts, Transfer of Permit, and Withdrawl of
Permit Application and/or modification requests must be submitted on the appropriate form:
MAIL ORIGINAL FORM WITH INK SIGNATURES TO THE FOLLOWING ADDRESS:
Colorado Dept of Public Health and Environment
Water Quality Control Division
4300 Cherry Creek Dr South WQCD-P-B2
Denver, CO 80246-1530
FAXED or EMAILED FORMS WILL NOT BE ACCEPTED
• PART A. IDENTIFICATION OF PERMIT Please write the permit number to be modified
PERMIT NUMBER CO -0000906
• PART B. PERMITEE INFORMATION (application must be signed by the legal contact listed here)
Company Name New Elk Coal Company LLC
Mailing Address 12250 Highway 12
City
Weston
Legal Contact Name Louis Head
Title President
• PART C. FACILITY/PROJECT INFORMATION
Facility/Project Name New Elk Mine
State CO Zipcode 81091
Phone
Number 719-613-6141
Email [e-mail]
Location (address) 12250 Highway 12
City Weston County Las Animas
Jim Be ano Phone [phone]
Local Contact Name g Number
Title Manager
Email [e-mail]
Page 1 of 2 form last revised December 2011