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COLORADO DIVISION OF RECLAMATION, MINING AND SAFETY <br /> 1313 Sherman Street, Room 215, Denver, Colorado 80203, (303) 866-3567 <br /> «1876« <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 - 022 Date: 02 / 25 / 2020 <br /> Permittee. OXBOW MINING, LLC. <br /> Street: 3737 HWY 133, PO BOX 535 <br /> City: SOMERSET <br /> State: CO Zip Code: 81434 - <br /> Brief Description of Revision: TECHNICAL REVISION 78 (TR-78) DESCRIPTION <br /> AND CLARIFICATION TO POST MINING INDUSTRIAL USE <br /> LOCATIONS, INCLUDING RAILROAD RIGHT OF WAYS <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 (+/-) _ _ _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 (+/-) _ _ . _Acres Mineral State (+/-) 0 _ _ —Acres <br /> Mineral Federal (+/-) 0 _ _ —Acres <br />