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COLORADO DIVISION OF RECLAMATION, MINING AND SAFETQ <br />1313 Sherman Street, Room 215, Denver, Colorado 80203, (303) 866 - 35670 <br />C3 2,,VZP <br />APPLICATION FORM FOR A REVISION ,>` d <br />TO A COAL MINING AND RECLAMATION PERMIT S3`s4 <br />This form must be completed and submitted with all r equests 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 Ru le 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 cove r letter to the revision should explain the nature of the <br />revision and reference the specifiqpermit 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 sub mitted to the Division, and pr oof 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 />c _ 81 8 <br />Western Fuels- Colorado <br />Street: P.O. Box 628 <br />27646 W. 5th Ave <br />City: Nucla <br />State: CO Zip Code: 81424 <br />Brief Description of Revision: <br />result locations. <br />Date: 05 / 23 / 2012 <br />Addition of TR -61 SAP results to Attachment 2.04.9- <br />1 u. Modification of Section . z.u4.y to indicate SAP <br />Public Notice Attached: Yesfl No (Required for PRs and TRs) <br />Bond Increase: Yesn No Federal rl Non - Federal Mine <br />Proposed Change in: <br />Permit Area - Surface Ownership - <br />Disturbed ( + / -)U _ _ . _ Acres Private Land ( + / -) 0 _ _ _ Acres <br />Permit ( + / -)0 _ _ Acres Federal Land (+1 0 _ _ _ Acres <br />Affected ( + / -)0 _ _ _ Acres State Land ( + / -) 0 _ _ _ Acres <br />Mineral Ownership - <br />Mineral Private ( + / -) 0 — _ _ Acres Mineral State ( +/ -) 0 _ _ _ Acres <br />Mineral Federal ( + / -) 0 _ _ _ Acres <br />