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<br />APPLICATION FORM FOR A REVISION NpR Q3 2??9 <br />TO A COAL MINING AND RECLAMATION PERMIT n °t a d,Sa ebi n <br />o1v?s?o <br />M?r?n9 <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 />X04 C0 <br />*»O. COLORADO DIVISION OF MINERALS AND GEOLOGY <br />• ,6 • 1313 Sherman Street, Room 215, Denver, Colorado 80203, (303) 866-3567 <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 comer 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: March / 31 / 2009 <br />Permittee: Oxbow Mining, LLC. <br />Elk Creek Mine <br />Street: 3737 State Highway 133 <br />P.O. Box 535 <br />City: Somerset <br />State: Co. Zip Code: 81434 _ <br />Brief Description of Revision: TR- 62 - Ventilation Boreholes <br />Public Notice Attached: Yes ? No J (Required for PRs and TRs) <br />Bond Increase: Yes ? No Federal ? Non-Federal Mine <br />Proposed Change in: <br />Permit Area - <br />Disturbed 4 1 7 Acres <br />Permit o Acres <br />Affected o _ Acres <br />Mineral Ownership - <br />Mineral Private _ 0 -Acres <br />Mineral Federal 0 . - Acres <br />Surface Ownership - <br />Private Land 0 Acres <br />Federal Land 0 Acres <br />State Land 0 . Acres <br />Mineral State 0 Acres