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0, C-- <br />&--1 COLORADO DIVISION OF RECLAMATION, MINING AND SAFETY <br />` 1313 Sherman Street, Room 215, Dem er; Colorado 80203, (303) 866 -3567 <br />APPLICATION FORM <br />RENEWAL OF A VALID, EXISTING PERMIT <br />TO CONDUCT MINING IN COLORADO <br />This form is an application for successive renewal of a valid, existing permit to conduct surface or underground mining <br />and reclamation activities or other surface coal mining and reclamation operations in Colorado pursuant to C.R.S. 34 <br />33 -101, et seq. This application form is designed to revise and update the application form currently included in your <br />permit application. The right of successive renewal applies only to lands and activity which were permitted during the <br />previous term. Extensions of the permit area and significant new activity within the permit area are subject to the <br />review procedures applicable to new permit applications, in accordance with Rule 2.08.5(1)(c) and 2.08.4. <br />For a renewal application to be deemed complete by the Division pursuant to C.R.S. 34- 33- 109(7), an applicant must <br />submit: (1) all information as specified on this application form; (2) a copy of the newspaper notice; (3) evidence that a <br />liability insurance policy, will be provided for the proposed period of renewal, and (4) five reproducible copies of the <br />permit renewal application with original signatures. <br />For federal mines, a copy of the renewal application must be submitted to all agencies on the federal agency mailing list <br />at the same time the application is submitted to the Division, and proof of distribution must be submitted to the <br />Division. Copies of renewal pages modified during the review process must be distributed in the same manner; along <br />with proof of distribution. Proof of distribution must be submitted prior to implementation of the renewal. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly the appropriate information as listed below. Supplemental sheets may be used as <br />necessary. Such sheets must be attached to the form and referenced or keyed to the numbers on the form. <br />1. Permittee: GCC Energy, LLC <br />2. Name of Operation: King I Mine <br />3. Permit Number (same as current permit number): C - 81 -035 <br />4. Type of Revision: R N Renewal Number: 06 <br />5. Application Submittal Date: 02/08/2012 <br />