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.;1 COLORADO DIVISION OF RECLAMATION, MINING AND SAFETY <br />,RZ1313 Sherman Street, Room 215, Denver, Colorado 80203, (303) 866-3567 <br />APPLICATION FORM FOR A REVISION MAY 18 Z009 <br />TO A COAL MINING AND RECLAMATION PERMIT Division.. <br />Whining and ?s.s2ty' <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 />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 - ed - 006. Date: Cis / f ( / Cq <br />Permittee: CC8L GOMPAAIV <br />Street: f-5 1=A-eS T _M N i N <br />City: F LakEt4 c E. <br />State: et0 Zip Code: 226 - <br />Brief Description of Revision: TECAAifUhL RE 0 6W AI l cRC% S'i' <br />TR ? Z?? `?? c rI A?IC E 7'l ?p 1. F <br />ISTAsTUS 'To i2liRM411" 1 <br />Public Notice Attached: Yesp-N No (Required for PRs and TRs) <br />Bond Increase: Yes[] No? Federal R. Non-Federal ? Mine <br />Proposed Change in: <br />Permit Area - Surface Ownership - <br />Disturbed 4 , 2 Acres Private Land 0 0 2 Acres <br />Permit O Q 2 Acres Federal Land V,Q Acres <br />Affected (+/-) _ ° Q P '") Acres <br />Mineral Ownership - <br />Mineral Private (+/-) _ _ c7 .'O Acres <br />State Land (+/-) O, b Acres <br />Mineral State (+/-) ©, Acres <br />Mineral Federal (+/-) 0 . 0 Acres