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This form must be completed <br />revisions, as defined in Rule 1 <br />requirements of Rule 2.08.4. <br />complete. <br />All revisions are to be formatted so they can be inserted into the, permit to replace the revised sections, maps, tables and /or <br />figures; With a table of contents, if necessary. The revision submittal date ghould.b printed in the lower right corner <br />of eaclo'evision page. A cover letter. to the revision should explain the nature of the revision and reference the specific permit <br />sections being revised. <br />For federal mines, a copy of the revision application must be submitted to all agencies on the federal mailing list (except <br />OSM) at the same time the application is submitted to the Division, and proof of distribution must be submitted to the <br />Division along with the application. Copies of revision pages modified during the review process must be distributed in the <br />same manner, along with proof of distribution. Proof of distribution must be submitted prior to implementation of the <br />revision. <br />Permit No.: <br />Permittee: <br />Street: <br />City: <br />State: <br />Surface Private <br />Surface Federal <br />Surface State <br />COLORADO DIVISION OF RECLAMATION, MINING AND SAFETVt <br />1313 Sherman Street, Room 215, Denver, Colorado 80203, (303) 866 -3567 <br />RECEIVED <br />- APPLICATION FORM FOR A REVISION ' SEP 2 8 2012 <br />TO A COAL MINING AND RECLAMATION PERMIT <br />D ivision of Reclafety <br />mafy011. <br />, <br />and submitted with all requests for minor revisions, as defined in 12uIe ti, ,, j.64 73)& S , a technical <br />.04(136), and permit revisions, as defined in Rule 1.04(90). All revisions are to address the <br />Three (3) copies of the revision, including maps, must be submitted in order for it to be <br />C- 2009 -087 <br />Peabody Sage Creek Mining, LLC <br />36600 RCR 27 <br />Hayden <br />Colorado Zip Code: 81639 <br />Brief Description of Revision: Water and Gas Line Geotechnical Evaluation <br />Public Notice Attached: Yes _ No X (Required for PRs and TRs) <br />Bond Increase: Yes X No Federal X Non - Federal Mine <br />Proposed Change in: <br />Permit Area - <br />Disturbed ( + / -) 0.0 Acres <br />Permit ( + / -) 0.0 Acres <br />Affected ( + / -) 0.0 Acres <br />Surface Ownership - Mineral Ownership - <br />( + / -) 0.0 Acres <br />( + / -) 0.0 Acres <br />( + / -) 0.0 Acres <br />Mineral Private <br />Mineral Federal <br />Mineral State <br />Date: September 25, 2012 <br />( + / -) 0.0 Acres <br />( + / -) 0.0 Acres <br />( + / -) 0.0 Acres <br />