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COLORADO DIVISION OF RECLAMATION, MINING AND SAFETY <br />+ » 1313 Sherman Street, Room 215, Denver, Colorado 80203, (303) 866-3567 <br />1878 # <br />APPLICATION FORM <br />RENEWAL OF A VALID, EXISTING PERMIT <br />TO CONDUCT MINING IN COLORADO <br />This form is an application for successive renewal of a valid, existing permit to conduct surface or <br />underground mining and reclamation activities or other surface coal mining and reclamation operations in <br />Colorado pursuant to C.R.S. 34-33-101, of seq. This application form is designed to revise and update <br />the application form currently included in your permit application. The right of successive renewal applies <br />only to lands and activity which were permitted during the previous term. Extensions of the permit area <br />and significant new activity within the permit area are subject to the review procedures applicable to new <br />permit applications, in accordance with Rule 2.08.5(1)(c) and 2.08.4. <br />For a renewal application to be deemed complete by the Division pursuant to C.R.S. 34-33-109(7); an <br />applicant must submit: (1) all information as specified on this application form; (2) a copy of the <br />newspaper notice; (3) evidence that a liability insurance policy will be provided for the proposed period of <br />renewal; and (4) five reproducible copies of the permit renewal application with original signatures.; <br />For federal mines, a copy of the renewal application must be submitted to all agencies on the federal <br />agency mailing list at the same time the application is submitted to the Division, and proof of distribution <br />must be submitted to the Division. Copies of renewal pages modified during the review process must be <br />distributed in the same manner, along with proof of distribution. Proof of distribution must be submitted <br />prior to implementation of the renewal. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly the appropriate information as listed below. Supplemental sheets may be used as <br />necessary. Such sheets must be attached to the form and referenced or keyed to the numbers on the <br />form. <br />Permittee: /w•Ftii y/J!_rl.C OA.C CO??d/3git?l? <br />2. Name of Operation: / '?•r? a,6x e 5;toe' <br />3. Permit Number (same as current permit number): C - J? Z - a --ric <br />4. Type of Revision: R I Renewal Number. 3 <br />5. Application Submittal Date: // / ,Z3 / O 7