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of c <br />Ne i <br />#$ COLORADO DIVISION OF MINERALS AND GEOLO Y?1EIVf'D <br />1876 ` 1313 Sherman Street, Room 215, Denver, Colorado 80203, (303) 866-3567' <br />APPLICATION FORM FOR A REVISION ,,, rteclama?n, <br />TO A COAL MINING AND RECLAMATION PERMIT v Y a+ir?.n9 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 are to <br />address the requirements of Rule 2.08.4. Three (3) copies of the revision, including maps, must be submitted in <br />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, tables <br />and/or figures, with a revised table of contents, if necessary. The revision submittal date should be printed in the <br />lower right corner of each revision page. A cover letter to the revision should explain the nature of the revision and <br />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 - 92 - 081 Date: 02 /18 /2010 <br /> Permittee: Hayden Gulch Terminal LLC <br /> P.O. Box 670 <br /> Street: 37796 Routt County Road 53 <br /> City: Hayden <br /> State: CO Zip Code: 81639 - 0670 <br /> Brief Description of Revision: MR 19 provides updated information regarding name change and <br /> local contact <br /> Public Notice Attached: Yes No X (Required for PRs and TRs) <br /> Bond Increase: Yes No X Federal X Non-Federal Mine <br /> Proposed Change in: <br /> Disturbed Area (+/-) 0 0 Acres Affected Area (+/-) 0 0 Acres <br /> Permit Area (+/-) 0 0 Acres Federal Land (+/-) 0 0 Acres <br /> State Land (+/-) 0 0 Acres Private Land (+/-) 0 0 Acres <br />•