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,,~: COLORADO D~VLSION OF MINERALS AND GEOLOGY <br />~, 1313 Sherman Stre ,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(731, <br />technical revisions, as defined in Rule 1.04(136), and permit revisions, as defined in Rule 1.04(90). All <br />revisions are to address the requirements of Rule 2.08.4. Three 131 copies of the revision, including maps, <br />must be 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 <br />printed in the lower right corner of each revision page. A cover letter to the revision should explain the nature <br />of the 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 <br />list (except OSM) at the same time the application is submitted to the Division, and proof of distribution must <br />be submitted to the Division along with the application. Copies of revision pages modified during the review <br />process must be distributed in the same manner, along with proof of distribution. Proof of distribution must <br />be submitted prior to implementation of the revision. <br />Permit No.: C - 81 - 041 Date: 11 / 29 / O1 <br />Permittee: Powderhorn Coal Company <br />Roadside Mines <br />Street: <br />City: <br />State: <br />P.O Box 1430 <br />Palisade <br />CO Zip Code: 81526 - <br />Briet Description of Revision: Partially reclaim pond 12 . Breach <br />embankment between pond 5 and pond 12 <br />so pond 12 becomes a sub-drainage area <br />to sediment pond 5. <br />Public Notice Attached: Yes xx No _ (Required for PR's and TR's) <br />Bond Increase: Yes No XX Federal XX Non-Federal Mine <br />Proposed Change in: <br />Disturbed Area (+/-) _ _ 0 . 0 Acres Affected Area (+/-) _ _ 0 . 0 Acres <br />Permit Area (+/-) _ _ 0 .0 Acres <br />Federal Land (+/-) <br />_ _ 0.0 Acres <br />State Land (+/-) _ _ 0 . 0 Acres Private Land (+/-) _ _ 0 . 0 Acres <br />