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iii iiinuiiiiuiii STATE OF COLORADO DIVISION OF MINERALS AND GEOLOGY Deiunmenr of Natural Re:oun:es RECEIVE D I7I7 Sherman 51.. Room 2I5 Denver. Colorado 8020) Phone: r1071866-7567 ~ I~~B F.~x:uo7is7z•aioe APPLICATION FORM FOR A R IS1 OCT TO A COAL MINING AND RECLAMA ON EPAATN1Q~TaF DIV. OF MINERALS Lli ~JitL1L. &GEOLOGY FC(1TTR~`T=C This form must be completed and submitted with all requests for minor revisions, as defined in Rov ROrrer Rule 1.041731, technical revisions, as defined in Rule 1.04(1361, and permit revisions, as defined cO"`A10f in Rule 1.04(90). All revisions are to address the requirements of Rule 2.08.4. Three 13) copies E ~~,;~o ~« of the revision, including maps, must be submitted in order far it to 6e complete. .V¢haN a. lone Diriaion Oirenrx All revisions are to be formatted so they can be inserted into the permit to replace the revised sections, maps, tables and/or figures, with a revised table of contents, if necessary. The revision submittal date should be printed in the lower right corner of each revision page. A cover letter to the revision should explain the nature of the revision and reference the specific permit sections being revised. For federal mines, a copy of the revision application must be submitted to all agencies on the federal mailing list at the same time the application is submitted to the Division, and proof of distribution must he submitted to the Division along with the application. Copies of revision pages modified during the review process must be distributed in the same manner, along with proof of distribution. Proof of distribution must be submitted prior to implementation of the revision. For non-federal mines, a copy of the application for which the Division has issued a proposed approval decision must be submitted to the OSM Western Regional Coordinating Center 11999 Broadway Blvd., Suite 3320, Denver, CO 80202-57331, and proof of submittal to OSM must be submitted to the Division prior to implementation of the revision. Permit No.: C- 8 2 0 5 6 Date: ~~ l 1~ I~~ Permittee: T W E N T Y M I L E C O A L_ C O M ~ A N Y_ Street: 2 9 5 1 5 R O U T T_ C O U N T Y R O A D _ # 2 7 _ _ _ _ _ _ _ City: O A K _ C R E E ~I_-- _--- State: C O Zip Code: 8 ~ 4 6 7 - _ _ _ _ Brief Description of Revision: Drillin gs of Tro ut Creek Sandsto ne tact holPc Public Notice Attached: Yes _ No X (Required for PRs and TRs) Bond Increase: Yes X No _ Federal _ Non-Federal _ Mine Proposed Change in: Disturbed Area (+l-) _ _ 2 . ~ Acres Affected Area (+l-) _ _ ~ . ~ Acres Permit Area (+/-) _ _ ~ ~ Acres Federal Land (+/_) _ _ ~ , ~ Acres State Land (+/_) _ _ 0 0 Acres private Land (+I_) ` _ 0 0 Acres