2011-06-03_REVISION - C2009087

• Permit No: C2009087
• IBM Index Class Name: REVISION
• Doc Date: 6/3/2011
• Doc Name: Letter & Application
• From: Peabody Sage Creek Mining, LLC
• To: DRMS
• Type & Sequence: MR3
• Email Name: JDM
• Media Type: D
• Archive: No

Form EXEMPT PERMIT INFORMATION SHEET
No. 09 STATE OF COLORADO
OFFICE OF THE STATE ENGINEER
821 Centennial Bldg., 1313 Sherman SL, Denver, Colorado 80203
(303) 868,3581 Fax [phone]
INFORMATION FOR WELL PERMITS APPROVED PURSUANT TO CRS 37-92-802
(HOUSEHOLD, DOMESTIC, LIVESTOCK AND EXEMPT COMMERCIAL USES)
Carefully had the conditions of approval on your well penMf. The conditions and the Information on tJds
infomudon sheet must be compiled with in order for the permit to remain valid.
The well must be constructed and
THE PERM[[ goRAMN DATE IS TWO ff" F3QN THE DATE M evidence of We construction must be m cohmd by this office in the form of a Wei Construction and Test report from
the well construction contractor cormfi?ing that tie well w? constructed prior to a)dM of the well permit. The
well permit number Is located in the upper right hand comer of the permit, and the yew expiration date is located h the ewer right hand corner. The expiration date of the permit may
be extended one at a time at the discretion of
wsD, a wetter
the State Engineer for good cause shown. N an extension of time Is necessaryto to construct " expiration dfb of the well
request for the extension of time must be received by this office prior to
permit, In the requests you must provide the well permit numbsr,?nn? an and i? ling dress and the
reasons why the well has not been constructed and approximatshl cocted.
Water well construction and pump Installation contractors are specifically licensed In Colorado to perform these
specialbod tasks. it is Illegal for contractors who do not hold these kensss to construct wells andl r Ins?pumping *sdors
currort
equipment in or on wells. The well must be constructed and the ? ? tinstalled he reverse . by sioor de Planes ask to see
It. ense(e) Issued by the State of Colorado unless exempted as Consttuctbn
their license(s). Bacldwe Opomtore and Uosr*W Plumber may or may not hold the respective Well and/or Pump Installation licenses. Please be aware of this well yield must be submitted
to the office of
pumping equipment The well construction report n cludbmg after expiration of the
the State Engineer within sbdy (60) days of completion of the work or wbhin seven be submitted within
permit, whictrever is eadler. The pump installation report including a pumping system a ropy must
work report(s) filed
of the
ably (80) days of completion of the work The contractor(s) must provide you with
with to Stets Engineer. The Web Construction and Test Report Form Number GWS-31 and the Pump Ir tion
and Test Regard Fore Number GWS-32 we available ?irthe* Division of We* Resources ofta. Additional
?ed besting and well Pk Ing and sealing regulations
inforrrration regarding web construction, pump Installation, are found on the reverse side of this sheet.
You have been provided with at least two copies of the wail permit Keep a copy for your records. There Is
also a copy for the pump installation contractor. Copies have been sent to the driller If you Indicated a driller licence number on the application, or two additional copies have been
enclosed. You may make addition
copies for the web construction contractor if you select one different from the one
oindicated In your btained for The of 50 application.
? per
The original permit is on ifie in the Denver offios Records Section. Copies may to to State Engineer. 50 a Form
page. Statutes require that any change of mailing address or ownership be reported
number GWS-11 Is used both by new owners to report ownership changes and current owners to report address
changes.
If you have questions, contact the Denver Office, or the Division Offios in the area where your wall Is located.
_ n?s.t.... A
8100 St. 2nd Floor
Greeley, CO 80831
19701352-8712
31 O E Abrlendo Ave Ste B 301 Murphy Drive
Pueblo, CO 81004 Aisrmose, CO 81101
[phone] (719) 5896883 _'
1871 East Main St
Montrose, CO 81401
(97012494822
Direct mall to Box 398
Glenwood Spgs CO 81602
50633 U.S. Hwy 6 S 24
Glenwood Spgs.. CO 81601
(970) 9454865
Fax [phone] Call first
Direct mal to so 773450
508 Millers Dr. Suite 101
Steamboat Spgs, CO
80477
[phone]
Fox(970)879-1070
160 Rods Point Dr., See. E
Durango, CO 81301
[phone]
Fax [phone]
1313 Sherman St Rm. 818
Denver, CO 80203
[phone]
Fax [phone]