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:; <br />? 7 a <br />pD <br />?pp???OV 1 ? ?Q10 <br />COLORADO DIVISION OF MINERALS AND GEOLOGY ig,?i1 U7 ???sl.l <br />1313 Sherman Street, Room 215, Denver, Colorado 80203, (303) 866-3567 f ?? ark S? <br />APPLICATION FORM FOR A REVISION <br />TO A COAL MINING AND RECLAMATION PERMIT <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 OSN? 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.: <br />Permittee: <br />Street: <br />C - 92 - 081 Date: 11 /15 /2010 <br />Hayden Gulch Terminal, LLC <br />P.O. Box 670 <br />37796 Routt County Road 53 <br />City: Hayden <br />State: CO Zip Code: 81639 - 0670 <br />Brief Description of Revision: MR 21 provides updated information regarding mid-term comments <br />Public Notice Attached: Yes <br />Bond Increase: Yes <br />Proposed Change in: <br />Disturbed Area (+/-) <br />Permit Area (+/-) <br />State Land (+/-) <br />No X (Required for PRr and 7Rs) <br />No X Federal X Non-Federal Mine <br />0 Q Acres Affected Area (+/-) 0 0 Acres <br />Q 0 Acres Federal Land (+/-) 0 Q Acres <br />Q 0 Acres Private Land (+/-) Q 0 Acres