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STATE OF COLORADO DIVISION OF MINERALS AND GEOLOGY • fkyanmenr of Natural Resources I ! I) Sherman Sf.. Room 715 Denver, ColoraAo 80703 Pha+e: 0077 866-7567 FA%: 170)1872.81pb APPLICATION FORM FOR A REVISION TO A COAL MINING AND RECLAMATION PERMIT This form must be completed end submitted with all requests for minor revisions, as defined in Ror gars. Rule 1.041731, technical revisions, es defined in Rule 1.041138), and permit revisions, as defined ~O"rt10' in Rule 1.041901. All revisions are to address the requirements of Rule 2.08.4. Three 131 copies Exe~cuuYe a. K IX of the revision, including maps, must be submitted in order for it to be complete. Michael B Long OIYISIan Dlrecrar All revisions are to ba formatted so they can be inserted into the permit to replete 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 tower right corner of each revision page. A cover fetter 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 agendas on the federal mailing list at the same time the application is submitted to the Division, and proof of distribution must be 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 -8Q 09~- _ _ _ Date: L L / S S / 4 ~ Permittee: ~,_~ COAL COMPANY- - - - - - - - - - - - - - - - Street: ONE TOWN CENTER ROAD - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - City: BOCARATON ___________ State: ~,_ Zip Code: 33486 _ _ _ - _ _ _ _ Brief Description of Revision: nET.F.TF. IxArr.ROED~aO~OlIT A8->;l1_ANR ~AC7LIT~ES Public Notice Attached: - - - - - - - - - - Yes X No _ lRequi~ed log PRs and TRsI - - - - Bond Increase: Yes _ No ~ Federal _ Non-Federal X Mine Proposed Change in: Disturbed Area (+/-) _ _ 0 .0 Acres Affected Area 1+!-) _ _ ~ . ~ Acres Permit Area (+/-) _ _ ~ . ~ Acres Federal Land (+/-) _ _ 0 0 Acres State Land 1+/-) _ _ 0 0 Acres Private Land (+/-) _ _ ~ . ~ Acres m:lcoal\share\forms\8866