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:.. COLORADO DIVISION OF MINERALS AND GEOLOGY REC'~'~vED <br />. , 1313 Sherman Street, Room 215, Denver, Colorado 80203, (303) 866-3567 <br />APPLICATION FORM FOR A REVISION oryuwo°'M"1e`aea°eoe~ <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 2.06.4. 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 - 80 - 007 Date: 07 / 26 / 05 <br />Permittee: Mountain Coal Company <br />West Elk Mine <br />Street: P.O. Box 591 <br />1 Mile East of Somerset on Hwy 133 <br />c;ty; Somerset <br />State: CO Zip Code: 81434 _ <br />Brief Description of Revision: Technical Revision 103 for construction <br />of an access road, two drill pads and <br />drilling four Methane Drainage Wells, <br />20-04, 20-05, 21-05 and 21-06 in Box Cyn. <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 (+/-) _ _ _ _ Acres <br />Permit (+/-) _ _ _ . _ Acres <br />Affected (+/-) _ _ _ _ Acres <br />Mineral Ownership - <br />Mineral Private (+/-) _ _ _ . -Acres <br />Mineral Federal (+/-) _ _ _ _ Acres <br />Federal Land (+/-) _ _ _ . _ Acres <br />State Land (+/-) _ _ _ • _ Acres <br />Mineral State (+/-) _ _ _ . _ Acres <br />