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COLORADO DIVISION OF RECLAMATION, MINING AND SAFETY <br />1313 Sherman Street, Room 215, Denver, Colorado 80203, (303) 866 -3567 RECEIVED <br />APPLICATION FORM FOR A REVISION <br />TO A COAL MINING AND RECLAMATION PERMIT Division of Reclamation, <br />Mining & Safety <br />This form must be completed and submitted with all requests for minor revisions, as defined in Rule 1.04(73), technical <br />revisions, as defined in Rule 1.04(136), and permit revisions, as defined in Rule 1.04(90). All revisions are to address the <br />requirements of Rule 2.08.4. Three (3) copies of the revision, including maps, must be submitted in order for it to be <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 revised table of contents, if necessary. The revision submittal date should be printed in the lower right corner <br />of each revision 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.: C- 2009 -087 <br />Permittee: Peabody Sage Creek Mining, LLC <br />Street: 36600 RCR 27 <br />City: Hayden <br />State: Colorado Zip Code: 81639 <br />Brief Description of Revision: Septic Area Small Area Exemption <br />Public Notice Attached: Yes _ No X (Required for PRs and TRs) <br />Bond Increase: Yes No X 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 />Surface Private <br />Surface Federal <br />Surface State <br />( + / -) 0.0 Acres <br />( + / -) 0.0 Acres <br />( + / -) 0.0 Acres <br />Mineral Private <br />Mineral Federal <br />Mineral State <br />Date: November 12, 2012 <br />( + / -) 0.0 Acres <br />( + / -) 0.0 Acres <br />( + / -) 0.0 Acres <br />NOV 212012 <br />