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COLORADO DIVISION OF RECLAMATION, MINING AND SAFETY <br />1313 Sherman Street, Room 215, Denver, Colorado 80203, (303) 866 -3567 <br />This form must be completed and submitted with all requests for minor revisions, as defined in Rule <br />1.04(73), technical revisions, as defined in Rule 1.04(136), and permit revisions, as defined in Rule <br />1.04(90). All revisions are to address the requirements of Rule 2.08.4. Three (3) copies of the revision, <br />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 revised sections, <br />maps, tables and /or figures, with a revised table of contents, if necessary. The revision submittal date <br />should be printed in the lower right corner of each revision page. A cover letter to the revision should <br />explain the nature 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 <br />mailing list (except OSM) at the same time the application is submitted to the Division, and proof of <br />distribution must be submitted to the Division along with the application. Copies of revision pages <br />modified during the review process must be distributed in the same manner, along with proof of <br />distribution. Proof of distribution must be submitted prior to implementation of the revision. <br />Permit No.: C - 2009 - 087 <br />Permittee: Peabody Sage Creek Mine <br />Street: 36600 Routt County Road 27 <br />City: Hayden <br />APPLICATION FORM FOR A REVISION <br />TO A COAL MINING AND RECLAMATION PERMIT <br />State: CO Zip Code: 81639 - 0250 <br />Date: 02 01 2012 <br />Brief Description of Revision: MR -07 Location of Septic System and well permit updates <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 Surface <br />Ownership Ownership <br />Disturbed ( + / -) 0 . 0 Acres Private ( + / -) 0 . 0 Acres Private ( + / -) 0 . 0 Acres <br />Permit ( + / -) 0 . 0 Acres Federal ( + / -) 0 . 0 Acres Federal ( + / -) 0 . 0 Acres <br />Affected ( + / -) 0 . 0 Acres State ( + / -) 0 . 0 Acres State ( + / -) 0 . 0 Acres <br />