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1 <br />COLORADO DIVISION OF RECLAMATION, MINING AND SAPET1) <br />1313 Sherman Street, Room 215, Denver, Colorado 80203, (303) 866 -3567 65 <br />/g _4-46 _ <br />APPLICATION FORM FOR A REVISION ` �, �W; �tP i � <br />TO A COAL MINING AND RECLAMATION PERMIT O ts`�' <br />This form must be completed and submitted with all r equests 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 Ru le 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 bble of contents, if-necessary. The revision submittal date should be printed <br />in the lower right comer of each revision page. A cove r letter to the revision should explain the nature of the <br />revision and reference the specifiq ermit 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 sub mitted to the Division, and pr oof 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 />prlor to implementation of the revision. <br />Permit No.: C - 81 8 <br />Permittee: Western Fuels - Colorado <br />Street: <br />City: <br />State: <br />P.O. Box 628 <br />27646 W. 5th Ave <br />Nucla <br />CO zip code: 81424 <br />Addition of TR -61 SAP results to Attachment 2.04,9- <br />Brief Description of Revision: <br />Public Notice Attached: Yes0 No <br />Bond Increase: Yes❑ No <br />.rrsult k cations. <br />Proposed Change in: <br />Permit Area - Suckace <br />Disturbed (+/-)v_ _ _ . <br />Permit ( + / -)0 _ _ _ Acres <br />Affected ( + / -)0 Acres <br />Mineral Ownership - <br />Mineral Private ( + / -) 0 _ - _Acres <br />Mineral Federal ( + / -) 0 _ Acres <br />Date: 05 / 23 / 2012 <br />(Required for PRs and TRs) <br />Federal ❑ Non - Federal <br />Mine <br />Ownership - <br />Private Land ( + / -) 0 _ Acres <br />Federal Land ( +/ -) 0 . _ . Acres <br />State Land (+1--)0 ^ . _ Acres <br />Mineral State ( + / -) 0 _ _ Acres <br />