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//~..,, <br />a~S COLORADO DIVISION OF MINERALS AND GEOLOGY <br />1313 Sherman Street, Room 21 ~, Denver, Colorado 80203, (303) 866-3567 <br />r~~=~°",~riJJIC <br />APPLICATION FORM FOR A REVISION OCT 2 4 2003 <br />TO A COAL MINING AND RECLAMATION PERMIT Division of Minerals andGealoo•• <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: 10 / 21 / 2003 <br />Permittee: Oxbow Mining, LLC <br />Street: <br />City: <br />3737 Hwy 133 <br />P.O. Box 535 <br />Somerset <br />State: Co. Zip Code: 81434 _ <br />Brief Description of Revision: TR-44 --Construction of a petroleum storage facility and <br />equipment washbay. <br />Public Notice Attached: Yes / No (Required forPRs and TRs) <br />Bond Increase: Yes / No Federal / Non-Federal Mine <br />Proposed Change in <br />Permit Area - <br />Disturbed (+/-) _ _ o _ Acres <br />Permit (+/-) _ _ o . _ Acres <br />Affected (+/-) _ _ 0 . _ Acres <br />Mineral Ownership - <br />Mineral Private (+/-) _ _ 0 , -Acres <br />Mineral Federal (+/-) _ _ 0 _ Acres <br />Surface Ownership - <br />Private Land (+/-) _ _ o . _ gcres <br />Federal Land (+/-) _ _ o , _gcres <br />State Land (+/-) _ _ 0 . _gcres <br />Mineral State (+/-)_ _ ~ -Acres <br />