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Of'Cp <br />q?" g COLORADO DIVISION OF RECLAMATION, MINING AND SA <br />* 1313 Sherman Street, Room 215, Denver, Colorado 80203, (303) 866-3567 EGA <br />MAY APPLICATION FORM FOR A REVISION Division of t..,..... ran, <br />TO A COAL MINING AND RECLAMATION PERMIT Unln9 and Safety <br />This form must be completed and submitted with all requests for minor revisions, as defined <br />in Rule 1.04(73), technical revisions, as defined in Rule 1.04(136), and permit revisions, as <br />defined in Rule 1.04(90). All revisions are to address the requirements of Rule 2.08.4. Three <br />(3) copies of the revision, including maps, must be 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 <br />revised sections, maps, tables and/or figures, with a revised table of contents, if necessary. <br />The revision submittal date should be printed in the lower right corner of each revision page. <br />A cover letter to the revision should explain the nature of the revision and reference the <br />specific permit sections being revised. <br />For federal mines, a copy of the revision application must be submitted to all agencies on <br />the federal mailing list (except OSM) at the same time the application is submitted to the <br />Division, and proof of distribution must be submitted to the Division along with the <br />application. Copies of revision pages modified during the review process must be distributed <br />in the same manner, along with proof of distribution. Proof of distribution must be <br />submitted prior to implementation of the revision. <br />Permit No.: C - 2009 - 087 Date: 05/ 13/ 2011 <br />Permittee: Peabody Sage Creek Mine <br />Street: 36600 Routt County Road 27 <br />City: Hayden <br />State: CO Zip Code: 81639 - 0250 <br />Brief Description of Revision: TR03-11, Name Change and Adjudication File Updates <br />Public Notice Attached: Yes x No (Required for PRs and TRs) <br />Bond Increase: Yes No X Federal X Non-Federal Mine <br />Proposed Change in: <br />Permit Area Mineral Surface <br /> Ownership Ownership <br />Disturbed (+/-) 0 0 Acre Private (+/-) 0 0 Acres Private (+/-) 0 0 Acres <br /> s <br />Permit (+/-) 0 0 Acre Federal (+/-) 0 0 Acres Federal (+/-) 0 0 Acres <br /> s <br />Affected (+/-) 0 0 Acre State (+/-) 0 0 Acres State (+/-) 0 0 Acres <br /> s