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oF'Coto <br />COLORADO DIVISION OF MINERALS AND GEOLOGY <br />* 1313 Sherman Street, Room 215, Denver, Colorado 80203, (303) 866-3567 <br />M1876* <br />RECEIVED <br />APPLICATION FORM RENEWAL OF A VALID, EXISTING PERMIT TO <br />CONDUCT MINING IN COLORADO MM 19 toil <br />Division <br />Mining and Safety <br />This form is an application for successive renewal of a valid, existing permit to conduct surface or underground <br />mining and reclamation activities or other surface coal mining and reclamation operations in Colorado pursuant <br />to C.R.S. 34-33-10, et seq. This application form is designed to revise and update the application form currently <br />included in your permit application. The right of successive renewal applies only to lands and activity which <br />were permitted during the previous term. Extensions of the permit area and significant new activity within the <br />permit area are subject to the review procedures applicable to new permit applications, in accordance with Rule <br />2.08.5(1)(c) and 2.08.4. <br />For a renewal application to be deemed complete by the Division pursuant to C.R.S. 34-33-109(7), an applicant <br />must submit: (1) all information as specified on this application form; (2) a copy of the newspaper notice; (3) <br />evidence that a liability insurance policy will be provided for the proposed period of renewal; and (4) five <br />reproducible copies of the permit renewal application with original signatures. <br />For federal mines, a copy of the renewal application must be submitted to all agencies on the federal agency <br />mailing list at the same time the application is submitted to the Division, and proof of distribution must be <br />submitted to the Division. Copies of renewal pages modified during the review process must be distributed in <br />the same manner, along with proof of distribution. Proof of distribution must be submitted prior to <br />implementation of the renewal. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly the appropriate information as listed below. Supplemental sheets may be used as <br />necessary. Such sheets must be attached to the form and referenced or keyed to the numbers on the form. <br />Permittee: Chevron Mining Inc. <br />Name of Operation: Edna Mine <br />Permit Number (same as current permit number): C-80-001 <br />4. Type of Revision: RN Renewal Number: 06 <br />5. Application Submittal Date: 05/06/11