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Y w COLORADO DIVISION OF RECLAMATION MINING AND SAFETY <br /> * 4 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 _ 028 Date: 05 / 30 / 2019 <br /> Permittee: Coors Energy Company <br /> Street: 1801 California Street <br /> Suite 4600 <br /> City: Denver <br /> State: CO Zip Code: 80202 _ <br /> Brief Description of Revision: Addition of 6 monitoring wells as required by CDPHE <br /> permit. Data will be used by CDPHE. <br /> Public Notice Attached: Yes No ✓ (Required for PRs and TRs) <br /> Bond Increase: Yes No Federal Non-Federal Mine <br /> Proposed Change in: <br /> Permit Area - Surface Ownership - <br /> Disturbed +/- 0 Acres Private Land +/- 0 Acres <br /> Permit (+/-) 0 Acres Federal Land (+/-) 0 Acres <br /> Affected (+/-) 0 Acres State Land (+/-) 0 Acres <br /> Mineral Ownership - <br /> Mineral Private +/- . 0 Acres Mineral State +/- 0 Acres <br /> Mineral Federal W-) . 0 Acres <br />