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COLORADO DIVISION OF RECLAMATION, MINING AND SAFETY <br />1313 Sherman Street, Room 215, Denver, Colorado 80203, (303) 866- 3567., <br />APPLICATION FORM FOR A REVISION FEB 2 8 2013 <br />TO A COAL MINING AND RECLAMATION PERMIT <br />Division of Reclamation, <br />Mining & Safety <br />This form must be completed and submitted with all requests for minor revisions, as defined in Rule <br />1.04(73), technical revisions, as defined in Rule 1.04(136), and permit revisions, as defined in Rule 1.04(90). <br />All revisions are to address the requirements of Rule 2.08.4. Three (3) copies of the revision, including <br />maps, 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, <br />maps, tables and /or figures, with a revised table of contents, if necessary. The revision submittal date <br />should be printed in the lower right corner of each revision page. A cover letter to the revision should <br />explain the nature 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 <br />mailing list (except OSM) at the same time the application is submitted to the Division, and proof of <br />distribution must be submitted to the Division along with the application. Copies of revision pages <br />modified during the review process must be distributed in the same manner, along with proof of <br />distribution. Proof of distribution must be submitted prior to implementation of the revision. <br />Permit No.: C - 92 - 081 Date: 02 /26 /2013 <br />Permittee: Hayden Gulch Loadout <br />P.O. Box 670 <br />Street: 37796 Routt County Road 53 <br />City: Hayden <br />State: <br />CO Zip Code: 81639 0670 <br />Brief Description of Revision: TR- 10 provides information for Renewal 04 <br />Public Notice Attached: Yes X No (Required for PRf and 'I Rs) <br />Bond Increase: Yes No X Federal Non - Federal X Mine <br />Proposed Change in: <br />Disturbed Area ( + / -) 0 . 0 Acres Affected Area ( + / -) 0 . 0 Acres <br />Permit Area ( + / -) 0 . 0 Acres Federal Land ( + / -) 0 . 0 Acres <br />State Land ( + / -) 0 . 0 Acres Private Land ( + / -) 0 . 0 Acres <br />