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Permit No.: <br />Permittee: <br />Street: <br />City: <br />State: <br />COLORADO DIVISION OF MINERALS AND GEOLOGY <br />1313 Sherman Street, Room 215. Denver. Colorado 80203, (303) 866 -3567 <br />APPLICATION FORM FOR A REVISION <br />TO A COAL MINING AND RECLAMATION PERMIT <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(1 36), and permit revisions, as defined in Rule 1.04(90). All <br />revisions are to address the requirements of Rule 2.08.4. Three (3) copies of the revision, including maps, <br />must be 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 <br />printed in the lower right corner of each revision page. A cover letter to the revision should explain the nature <br />of the 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 <br />list (except OSM) at the same time the application is submitted to the Division, and proof of distribution must <br />be submitted to the Division along with the application. Copies of revision pages modified during the review <br />process must be distributed in the same manner, along with proof of distribution. Proof of distribution must <br />be submitted prior to implementation of the revision. <br />c- <br />Brief Description of Revision: <br />ENERGY FUELS GOAL, ING. <br />P.O. BOX '15 115 EAST MAIN <br />FLORENCE, CO 81226 <br />Zip Code: <br />RECEIVED <br />DEC 312012 <br />Division of Reclamation, <br />Minim & Safety <br />Date: (.2- / ?7 / <br />CZR Mw TJf lA/62- PEAIArr I li ,/I'(DA//TG)R <br />WELL /11 tu MAI 1v2 v) Vi RYt <br />FT T & t= kCJ L. I TA T E- f\ PP\ RTI P. t <br />06 NEAR (30=11136/v1 CE= \&J LL <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 />Disturbed Area (.: -) _ _ Q . 0 Acres Affected Area (+ /-1 _ _ D • 6 Acres <br />Permit Area (+ / -) _ _ 0 . O Acres Federal Land (+ i - — _ 0 . 0 Acres <br />State Land (+ / -) — — 0 . C0 Acres Private Land ( +' -) — C • 6) Acres <br />