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Vd <br />COLORADO DIVISION OF MINERALS AND GEOLO��� <br />•�8,6 1313 Sherman Street, Room 215, Denver, Colorado 80203, (303) 866- 3567EC <br />JUL 23 2013 <br />APPLICATION FORM FOR A REVISION DMSION AND MA710N <br />MIMING A AND SAFETY <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 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.: C - 1981 - 018 Date: 7 / 15 / 2013 <br />Permittee: Blue Mountain Energy, Inc. <br />Street: <br />3607 CR 65 <br />City: Rangely <br />State: Co Zip Code: 81648 _ <br />Brief Description of Revision: Drill five degas holes (LWB13 -1 thru 5), <br />five nitrogen iniection /monitoring holes (N10 -67. <br />N11 -15, 28, 43, and 59), 1520 additional feet of <br />nitrogen pipeline, and one return shaft RS -11 L along <br />with associated roads. <br />Public Notice Attached: Yes No ✓. (Required for PRs and TRs) <br />Bond Increase: Yes ✓ No <br />Federal ✓ <br />Non - Federal <br />Mine <br />Proposed Change in: <br />Permit Area - <br />Surface Ownership - <br />Disturbed ( + / -) _ _ <br />6. 87Acres <br />Private Land <br />( + / -) _ _ <br />_ —Acres <br />Permit ( + / -) _ _ <br />0. 1 Acres <br />Federal Land <br />( + / -) _ _ <br />_ . _ Acres <br />Affected ( + / -) _ _ <br />0. 31 Acres <br />State Land <br />( + / -) _ _ <br />_ —Acres <br />Mineral Ownership - <br />Mineral Private ( + / -) _ <br />_ _ _Acres <br />Mineral State <br />( + / -) _ _ <br />_ —Acres <br />Mineral Federal ( + / -) _ <br />_ _ —Acres <br />