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<br />COLORADO DIVISION OF MINERALS AND GEOLOGY <br />' ' X876 ` • 1313 Sherman Street, Room 215, Denver, Colorado 80203, (303) 866-3567 <br />APPLICATION FORM FOR A REVISION <br />X11 ?a1? TO A COAL MINING AND RECLAMATION PERMIT <br />A? his.form mUstlbe completed and submitted with all requests for minor revisions, as defined in Rule 1.04(73), <br />U gjwe* ions, as defined in Rule 1.04(136), and permit revisions, as defined in Rule 1.04(90). All revisions <br />t uto 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 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: May / 24 / 2010 <br />Permittee: Oxbow Mining, LLC. <br />Elk Creek Mine <br />Street: 3737 State Highway 133" <br />P.O. Box 535 7 ?01U <br />City: Somerset <br />State: Co. Zip Code: 81434 sat* <br />Brief Description of Revision: TR- 69 - Elk Creek Minepaln Update and Modification. <br />Public Notice Attached: Yes ? No _ (Required for PRs and TRs) <br />Bond Increase: Yes No ? Federal ? Non-Federal Mine <br />Proposed Change in: <br />Permit Area - Surface Ownership - <br />Disturbed 0 _ Acres Private Land 0 Acres <br />Permit o Acres Federal Land o _ Acres <br />Affected (+/-) ? ? 5 Acres State Land 0 Acres <br />Mineral Ownership - <br />Mineral Private 0 <br />Mineral Federal 0 <br />-Acres <br />_ Acres <br />Mineral State 0 Acres