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oF'??to <br />COLORADO DIVISION OF RECLAMATION, MINING AND SAFETY <br />1313 Sherman Street, Room 215, Denver, Colorado 80203, (303) 866-3567 REMNE® <br />APPLICATION FORM FOR A REVISION JuNUi1 <br />TO A COAL MINING AND RECLAMATION PERMIT u,. if Reclamation, <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 <br />revisions are to address the requirements of Rule 2.08.4. Three (3) copies of the revision, including maps, <br />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 revised sections, maps, <br />tables and/or figures, with a revised table of contents, if necessary. The revision submittal date should be <br />printed in the lower right comer of each revision page. A cover letter to the revision should explain the nature <br />of the 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 <br />list (except OSM) at the same time the application is submitted to the Division, and proof of distribution must <br />be submitted to the Division along with the application. Copies of revision pages modified during the review <br />process must be distributed 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: 6 01 2011 <br />Permittee: Peabody Sage Creek Mine <br />Street: 36600 Routt County Road 27 <br />City: Hayden <br />State: CO Zip 81639 - 0250 <br />Code: <br />Brief Description of Revision: MR-04 Additional Disturbance for Haul Road B and Well Permit <br />284387 <br />Public Notice Attached: Yes No x (Required for PRs and TRs) <br />Bond Increase: Yes _ No x Federal x Non-Federal Mine <br />Proposed Change in: <br />Permit Area Mineral <br />Ownership <br />Disturbed (+l-) 0 9 Acres Private (+l-) <br />Permit (+/-) 0 0 Acres Federal (+/-) <br />Affected (+/-) 0 0 Acres State (+/-) <br />Surface <br />Ownership <br />0 0 Acres Private (+/-) <br />0 0 Acres Federal (+/-) <br />0 . 0 Acres State (+/-) <br />0 0 Acres <br />0 0 Acres <br />0 . 0 Acres