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Permit No.: C -82 -056 <br />Permittee: Twentymile Coal, LLC <br />Street: 29515 Routt County Road 27 <br />City: Oak Creek <br />State: Colorado <br />Proposed Change in: <br />Permit Area <br />Disturbed <br />Permit <br />Affected <br />Surface Ownership <br />Private Land <br />Federal Land <br />State Land <br />COLORADO DIVISION OF RECLAMATION, MINING, AND SAFETY <br />1313 Sherman Street, Room 215, Denver, Colorado 80203, (303) 866 -3567 <br />APPLICATION FORM FOR A REVISION <br />TO A COAL MINING AND RECLAMATION PERMIT <br />This form must be completed and submitted with all requests for minor revisions, as defined in Rule 1.04(73), technical <br />revisions, as defined in Rule 1.04(136), and permit revisions, as defined in Rule 1.04(90). All revisions are to address the <br />requirements of Rule 2.08.4. Three (3) copies of the revision, including maps, must be submitted in order for it to be <br />complete. <br />All revisions are to be formatted so they can be inserted into the permit to replace the revised sections, maps, tables <br />and/or figures, with a revised table of contents, if necessary. The revision submittal date should be printed in the lower <br />right corner of each revision page. A cover letter to the revision should explain the nature of the revision and reference <br />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 (except <br />OSM) at the same time the application is submitted to the Division, and proof of distribution must be submitted to the <br />Division along with the application. Copies of revision 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 implementation of the <br />revision. <br />Zip Code: 80467 <br />Brief Description of Revision: 16 -Left Utility Borehole Installation (TR11 -78) <br />Public Notice Attached: Yes X No _ (Required for PRs and TRs) <br />Bond Increase: Yes X No Federal X Non - Federal Mine <br />8.3 Acres <br />0.0 Acres <br />0.0 Acres <br />0.0 Acres <br />0.0 Acres <br />0.0 Acres <br />RECEIVED <br />AUG 092011 <br />Ucvi:, a �i ,.zeiamati0n, <br />Mining and Safety <br />Mineral Ownership <br />Private Land 0.0 Acres <br />Federal Land 0.0 Acres <br />State Land 0.0 Acres <br />G: \Enviromnental\Revisions \Technical Revision \TR11 -78 16LT Utility Borehole.\ TR11 -78 I6LT Utility Borehole.App Form <br />Date: August 5, 2011 <br />