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Nam. <br /> #� g COLORADO DIVISION OF MINERALS AND GEOLOGY <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), <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 comer 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: 11 / 18 / 19 <br /> Permittee: Colowyo Coal Company, L.P. <br /> Street: 5731 State Highway 13 <br /> City: Meeker <br /> State: Co Zip Code: 81641 _ <br /> Brief Description of Revision: MR-211 provides documentation of a wildland <br /> fire that occurred adjacent to the Collom Haul <br /> Road. <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 .0 Acres Private Land (+/-)_ _ 0 . 0 Acres <br /> Permit (+/-)_ _ 0 . Q Acres Federal Land (+/-)_ _ 0 . 0 Acres <br /> Affected (+/-)_ _ 0 . 0 Acres State Land (+/-)_ _ 0 . 0 Acres <br /> Mineral Ownership - <br /> Mineral Private (+/-)_ _ 0 . 0 Acres Mineral State (+/-)_ — 0 0 Acres <br /> Mineral Federal (+/-)_ _ 0 . 0 Acres <br />