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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 <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(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 comer 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 />C_ 1 <br />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: Yes❑ No <br />isi <br />Proposed Change in: <br />Permit Area - +1.46 <br />Disturbed ( + / -) _ _ Acres <br />Permit ( +0+3.27 _ . _ Acres <br />Affected ( +/ -)0 _ _ _ Acres <br />Mineral Ownership - <br />Mineral Private ( + / -) 0 _ _ . _Acres <br />Mineral Federal ( + / -) 0 Acres <br />IIIdIIILCIId1IL !ICCub. <br />R BBg11ZD / 10 <br />APR 122013 <br />Division of Reclamation. <br />Mining & Satety <br />Addition of small areas to the permit in response to <br />CV- 2013 -003 and in preparation for future <br />No ®(Required for PRs and TRs) <br />Federal ® Non - Federal <br />Surface Ownership - <br />Private Land ( + / -) 0 _ Acres <br />( + / - ) 0 _ _ . _ Acres <br />( + / -) 0 _ _ . _ Acres <br />Federal Land <br />State Land <br />/ 2013 <br />Mine <br />Mineral State ( + / -) 0 _ _ . _ Acres <br />