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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(136), and permit revisions, as defined in Rule 1.04(90). All revisions <br />are to address the requirements of Rule 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 table of contents, if necessary. The revision submittal date should be printed <br />in the lower right corner of each revision page. A cover letter to the revision should explain the nature of the <br />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 list <br />(except OSM) at the same time the application is submitted to the Division, and proof 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 />prior to implementation of the revision. <br />Permit No.: <br />Permittee: <br />Street: <br />City: <br />State: <br />COLORADO DIVISION OF RECLAMATION, MINING AND SAFETY <br />1313 Sherman Street, Room 215, Denver, Colorado 80203, (303) 866 -3567 <br />_ 10 _ 89 <br />Western Fuels- Colorado <br />P.O. Box 628 <br />27646 W. 5th Ave <br />Nucla <br />CO Zip Code: 81424 <br />Brief Description of Revision: <br />Public Notice Attached: Yes <br />Bond Increase: YesE No <br />APPLICATION FORM FOR A REVISION <br />TO A COAL MINING AND RECLAMATION PERMIT <br />Fl <br />Fl <br />Proposed Change in: <br />Permit Area - <br />Disturbed ( + / -)U _ . _ Acres <br />Permit ( + / -)Q_ _ Acres <br />Affected ( + / -)Q _ _ Acres <br />Mineral Ownership - <br />Mineral Private (+1-) 0 _ _ _ Acres <br />Mineral Federal ( + / -) 0 Acres <br />Date: 02 / 25 / 2013 <br />Revision of overburden blasting section to include: <br />list of structure owners within pre blast survey area, <br />L I dbtel GCI hIIIC dJt CJIyi I, an vtl iC► dttdC.l !mull b. <br />No ❑(Required for PRs and TRs) <br />Federal n Non - Federal <br />Mine <br />Surface Ownership - <br />Private Land ( + / -) 0 _ Acres <br />Federal Land ( + / -) 0 _ Acres <br />State Land ( +1 -) 0 _ _ _ Acres <br />Mineral State ( + / -) ° _ _ _ Acres <br />