2012-04-10_REVISION - C1981008 (4)

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COLORADO DIVISION OF RECLAMATION, MINING AND SAFETY 1313 Sherman Street, Room 215, Denver, Colorado 80203, (303) 866 -3567 RECEfVID APPLICATION FORM FOR A REVISION TO A COAL MINING AND RECLAMATION PERMIT This form must be completed and submitted with all requests for minor revisions, as defined in Rule 1.04(73), technical revisions, as defined in Rule 1.04(136), and permit revisions, as defined in Rule 1.04(90). All revisions are to address the requirements of Rule 2.08.4. Three (3) copies of the revision, including maps, must be submitted in order for it to be complete. All revisions are to be formatted so they can be inserted into the permit to replace the revised sections, maps, tables and /or figures, with a revised table of contents, if necessary. The revision submittal date should be printed in the lower right corner of each revision page. A cover letter to the revision should explain the nature of the revision and reference the specific permit sections being revised. For federal mines, a copy of the revision application must be submitted to all agencies on the federal mailing list (except OSM) at the same time the application is submitted to the Division, and proof of distribution must be submitted to the Division along with the application. Copies of revision pages modified during the review process must be distributed in the same manner, along with proof of distribution. Proof of distribution must be submitted prior to implementation of the revision. c _ 81 - 8 Date: 09 / 04 / 2012 Permit No.: Permittee: Street: City: State: Proposed Change in: Permit Area - Disturbed Permit Affected Western Fuels- Colorado P.O. Box 628 27646 W. 5th Ave Nucla CO Zip Code: 81424 Brief Description of Revision: Updates to land ownership, executive committee, Public Notice Attached: Yes❑ No Bond Increase: Yes❑ No is Acres Acres Acres Mineral Ownership - Mineral Private ( + / -) 0 _ _ _ Acres Mineral Federal ( + / -) 0 _ Acres ana list of other mines operatea Dy permittee. (Required for PRs and TRs) Federal ❑ Non - Federal State Land is Mine Surface Ownership - Private Land ( + / -) 0 _ _ _ Acres Federal Land ( +/ -) 0 _ Acres ( +1 - ) 0 _ _ . _ Acres Mineral State ( + / -) 0 _ _ _ Acres APR- 10 2012 111213 Division of Reclamation, Mining and Safety