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COLORADO DIVISION OF RECLAMATION, MINING AND SAFETY <br />01). <br />1313 Sherman Street, Room 215, Denver, Colorado 80203, (303) 866-3567 <br />FtECEIVEDr- <br />APPLICATION FORM FOR A REVISION JUL 0 ? N09 <br />TO A COAL MINING AND RECLAMATION PERMIT <br />Uivi..... -oation, <br />mining and Safety <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 - 80 - 001 Date: 06 / 29 / 09 <br />Permittee: The Chevron Mining Company <br />Street: 116 Inverness Drive East <br />Suite 207 <br />City: Englewood <br />State: CO Zip Code: 80112 _ <br />Brief Description of Revision: The owners of lands contiguous to the permit area <br />(section 3.7.5.2) have been updated. <br />Public Notice Attached: YesE]No ® (Required for PRs and TRs) <br />Bond Increase: Yes® NoM? Federal 11 Non-Federal ® Mine <br />Proposed Change in: <br />Permit Area - Surface Ownership - <br />Disturbed (+/-) Acres Private Land 0 0 Acres <br />Permit 0. 0 Acres Federal Land 0 0 Acres <br />Affected 0. 0 Acres State Land (+/-) 0 0 Acres <br />Mineral Ownership - <br />Mineral Private <br />Mineral Federal <br />(+/-) 0 . 0 Acres <br />(+/-) 0 . 0 Acres <br />Mineral State (+/-) 0 0 Acres