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•C <br />' COLORADO DIVISION OF RECLAMATION MINING AND SAFETY <br />"•,,,6 • 1313 Sherman Street, Room 215, Denver, Colorado 80203, (303) 866-3567 <br /> <br />APPLICATION FORM FOR A REVISION <br />SEP 0 8 2010 <br />TO A COAL MINING AND RECLAMATION PERMIT Dieu,,,,, <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 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 - (R 21 - 0 l'L Date: _0 cl / 0:7 l 1-o I 0 <br />Permittee: fU E V E Lk LvA• L Co M e ,A n/ Y LLC <br /> 7_ <br />Street: _ 1 Z 2 W C -s T rrt V-1; T S T P- E &T <br />City: T Q% IV e 0,& n <br />State: C0 Zip Code: Ss 1 D 9 L - <br />Brief Description of Revision: A; ) j> -ri+6 t2C ma TE Go4l- LOADuu-r <br />S (T'E A-T' : A N 5 Tb -rqr- <br />Public Notice Attached: Yes No (Required for PRs and TRs) <br />Mineral Ownership - <br />Mineral Private <br />0. -Acres <br />Bond Increase: Yes®No Federal 11 Non-Federal Mine <br />Proposed Change in: <br />Permit Area - Surface Ownership - <br />Disturbed Acres Private Land Q .1- Acres <br />Permit Acres Federal Land 0 . _ Acres <br />Affected Acres State Land 0 . _ Acres <br />Mineral Federal <br />Acres <br />Mineral State (+/-) _ _ 0 . _ Acres