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COLORADO DIVISION OF RECLAMATION, MINING AND SAFETY <br />1313 Sherman Street, Room 215, Denver, Colorado 80203, (303) 866-3567 <br />p g 2011 APPLICATION FORM FOR A REVISION <br />G;ama%0 A COAL MINING AND RECLAMATION PERMIT <br />J'+ `- ?-1 <br />?lV1s?v= V r ea ?i?? <br />This forlIXIY lW 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 <br />are to address the requirements of Rule 2.08.4. Three (3) copies of the revision, including maps, must be <br />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 printed <br />in the lower right corner of each revision page. A cover letter to the revision should explain the nature of the <br />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 list <br />(except OSM) 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.: c - 81 _ 8 Date: 06 / 03 /2011 <br />Permittee: Western Fuels-Colorado <br />Street: P.O. Box 628 <br />27646 W. 5th Ave <br />City: Nucla <br />State: CO Zip Code: 81424 _ <br />Brief Description of Revision: Pond 015 as-built; NPDES discharge permit update <br />Public Notice Attached: Yes F No a(Required for PRs and TRs) <br />Bond Increase: Yes] No El Federal F Non-Federal Mine <br />Proposed Change in: <br />Permit Area - Surface Ownership - <br />Disturbed (+/-)0 -Acres Private Land (+/-) 0 -Acres <br />Permit (+/-)0 _ _ _ Acres Federal Land (+/-) 0 _ Acres <br />Affected -Acres State Land (+/-)o -Acres <br />Mineral Ownership - <br />Mineral Private (+/-) 0 _ _ -Acres Mineral State (+/-) 0 -Acres <br />Mineral Federal (+/-) 0 _ _ -Acres