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of co, <br />COLORADO DIVISION OF MINERALS AND GEOLOGY <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 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 - 1981 - 018 Date: 5 / 24 / 2012 <br />Permittee: Blue Mountain Energy, Inc. <br />Street: <br />Permit <br />Affected <br />APPLICATION FORM FOR A REVISION <br />TO A COAL MINING AND RECLAMATION PERMIT <br />3607 CR 65 <br />City: Rangely <br />State: CO Zip Code: 81648 <br />Brief Description of Revision: <br />Addition of Rock Dust Hole RDH -4, associated <br />facilities. and co- located Breathable Air Hole. <br />Public Notice Attached: Yes No ✓ . (Required for PRs and TRs) <br />Bond Increase: Yes ✓ No _ Federal ✓ Non - Federal _ Mine <br />Proposed Change in: <br />Permit Area - <br />Disturbed <br />( + / -) _ 0 , 98 Acres <br />( +/ -) _ 0 , 0 Acres <br />( +1 -) _ _ 0 , 0 Acres <br />Mineral Ownership - <br />Mineral Private ( +1 -) _ _ _Acres <br />Mineral Federal ( +1 -) _ _ _ . _ Acres <br />RecovE° <br />MAY 29 ?n» <br />DNV81011 or r <,-`Glemation. <br />Mining and Safety <br />Surface Ownership - <br />Private Land ( + / -) . _ Acres <br />Federal Land ( +/ -) _ _ _ . _ Acres <br />State Land ( +/ -) _ _ _ _ Acres <br />Mineral State ( +1 -) _ _ . _ Acres <br />