Form 3440-1 Application and License to Mine Coal (Free Use)

Form 3440-1 UNITED STATES (December 2019) DEPARTMENT OF THE INTERIOR BUREAU OF LAND MANAGEMENT APPLICATION AND LICENSE TO MINE COAL (FREE USE)	FORM APPROVED OMB NO. 1004-0073 Expires: January 31, 2020
	Office and Serial Number
No License may be awarded unless a completed Application form has been filed with the Bureau of Land Management (BLM). Mineral Leasing Act, as amended (30 U.S.C. 181 et seq.)	SUBMIT 4 COPIES

APPLICATION

We,

of

of

of

of

hereby apply for a license to mine and remove coal from the following-described land:

containing ^{acres, and in support of this application each states that he is a citizen of the United States and that the purpose for which the}

coal mined hereunder is to be used is:

^{for which approximately total of} tons is required annually. Is the filing fee attached? Yes No (If "no," explain)

LICENSE

In consideration of the granting of the license applied for, the applicant(s) hereby

^agree(s) to the following express terms and conditions to wit:

^{Sec. 1.} That only so much of the land as may be necessary to conduct mining operations hereunder will be used or occupied by said licensee(s). ^{The right is} reserved by the Bureau of Land Management (BLM) to dispose of any portion of said land not already disposed of with reservation to the coal deposits, under any act authorizing such disposition, such licensee(s) to observe in mining operations hereunder all provisions of the laws under which any part of the land has been or may hereafter be disposed of with reservation of the coal deposits therein and the right to mine and remove the same.

^{Sec. 2a.} That all mining and removal of coal hereunder will be conducted in accordance with approved methods and practices, as provided in the operating regulations (43 CFR 3480 and 30 CFR Chapter VII); that due provisions will be made for prevention of fires in the mine or mines opened hereunder and for the safety of miners or other workmen engaged therein, and reasonable diligence, skill, and care will be exercised in all mining operations hereunder.

2. Protection of surface, natural resources, and improvements. The licensee(s) ^agree(s) to take such reasonable steps as may be needed to prevent operations on the leased lands from unnecessarily; (1) causing or contributing to soil erosion or damaging crops, including forage, and timber growth thereon or on Federal or non- ^{Federal lands in the vicinity;} (2) ^{polluting air and water; (3) damaging improvements} owned by the United States or other parties; or (4) destroying, damaging or removing fossils, historic or prehistoric ruins, or artifacts; and upon any partial or total relinquishment or the cancellation or expiration of this license, or at any other time prior thereto when required and to the extent deemed necessary by the lessor to fill any pits, ditches and other excavations, remove or cover all debris, and so far as reasonably possible, restore the surface of the licensed land and access roads to their former conditions, including the removal of structures as and if required. The lessor may prescribe the steps to be taken and restoration to be made with respect to the

license lands and improvements thereon whether or not owned by the United States.

2. ^{Cultural Resources. If any items of historical, cultural, or archeological value} are discovered during performance of this license, licensee will immediately notify the BLM and not disturb such items or features until the BLM issues instructions. If licensee is ordered to take measures to protect any items or features of historical, cultural, or archeological value discovered during performance on this license, cost of the measures will be borne by licenser and such items and features will remain under jurisdiction of the United States.

^{Sec. 3.} That the license is granted for a period of 2 years from the date hereof, which may be extended upon application for such an extension and satisfactory showing as to the mining of coal from the land, giving the amount of coal mined, the dispositionmade thereof, and the condition of the mine.

^{Sec. 4.} That the right is reserved to cancel this license at any time, after a 30-day notice of such purpose, for failure to mine and use the coal deposits in accordance with the conditions and provisions of the act under which this license is issued, for committing waste or other unnecessary damage to the land or the deposits therein, for abandonment or nonuse, or for other violation of the terms of this license; that in case this license is canceled prior to its expiration, or expires by limitation, all mining machinery, tools, and appliances placed thereon by said licensee(s), except underground supports or structures necessary for the preservation of the mine, will be removed within 60 days from the date of expiration of notice of such cancellation; otherwise said machinery, tools, and appliances will become the property of the United States.

^{Sec. 5.} That the right is reserved to the Bureau of Land Management to permit, upon such terms as may determine to be just, for joint or several uses, such easements or rights-of-way, including easements in tunnels upon, through, or in said lands, as may be necessary or appropriate to the working of the same or of other

(Continued on page 2)

lands containing coal or other deposits described in said act, and the treatment and shipment of the products thereof by or under authority of the United States, its lessees or permittees, and for other public purposes; also the right to dispose of any other mineral deposits in the lands and the right to lease, sell, or otherwise dispose of the surface of the lands existing under law or laws hereafter enacted insofar as said surface is not necessary for the use of the licensee(s) in his operations hereunder.

^{Sec. 6.} Equal opportunity clause. The licensee will comply with all provisions of Executive Order No. 11246 of September 24, 1965, and the rules, regulations, and relevant orders of the Secretary of Labor. Neither licensee nor licensee's subcontractor should maintain segregated facilities.

Sec. 9. ^{Special Stipulations}

Sec. 7. That the licensee(s) must submit operation and production reports in accordance with the provisions of the operating regulations (43 CFR 3480 and 43 CFR 3440).

^{Sec. 8.} That operations under this license will be conducted in such a way as not to interfere with the administration and use of the land to a greater extent than may be determined by the Bureau of Land Management to be necessary for the most beneficial use of the land in case any of land described herein is embraced in a forest, reclamation, power or other withdrawal, or is segregated for any particular purpose.

WE CERTIFY That our purpose in obtaining this permit are consistentwith purposes set forth in 43 CFR 3440.

^{(Date) (Applicant's Signature) (Date)} (Applicant's Signature)

^{(Date) (Applicant's Signature) (Date)} (Applicant's Signature)

Title 18 U.S.C. Section 1001 and Title 43 U.S.C. Section 1212, make it a crime for any person knowingly and willfully to make to any department or agency of the United States any false, fictitious, or fraudulent statements or representations as to any matter within its jurisdiction.

LICENSE APPROVED

A license for the lands, described above, is hereby issued under the Mineral Leasing Act (30 U.S.C. 181), or Acquired Land Leasing Act (30 U.S.C. 351), and 43

CFR 3440, and is subject to all regulations now or hereafter in force when not inconsistent with any expressed and specific provisions herein, and to the terms and conditions forth in this license.

(Effective date of this license) (Bureau of Land Management)

(Continued on page 3) (Form 3440-1, page 2)

NOTICES

The Privacy Act and 43 CFR 2.48(d) require that you be furnished the following information in connection with information required by this form.

AUTHORITY: 30 U.S.C. 208 permits collection of the information requested by this form.

PRINCIPAL PURPOSE: The BLM will use the information you provide to process your application, to record adjudicative actions taken on your application and any subsequent license, to document administrative

actions taken, and to determine whether or not you are complying with the provisions of your license. ROUTINE USES: The BLM will only disclose this information in accordance with the provisions at 43 CFR 2. 56(b) and (c).

EFFECT OF NOT PROVIDING INFORMATION: Submission of the requested information is necessary to obtain a benefit. Failure to submit all the requested information or to complete this form may result in delay or preclude the BLM's acceptance of your application for a coal lease.

RELEVANT SYSTEM OF RECORDS NOTICE (SORN) CITATION: The Coal Lease Data System SORN may be found at 47 FR 55317 (December 8, 1982), modified by 73 FR 17376 (April 1, 2008).

The Paperwork Reduction Act requires us to inform you that:

BLM collects this information to determine whether or not you are qualified to hold a license to mine coal.

Submission of the requested information is necessary to obtain or retain a benefit.

You do not have to respond to this or any other Federal agency-sponsored information collection unless it displays a

currently valid OMB control number.

BXUGHQ +RXUV 6WDWHPHQW: Public reporting burden for this form is estimated to average 21 hours per response, including the time for reviewing instructions, gathering and maintaining data, and completing and

reviewing the form. You may submit comments regarding the burden estimate or any other aspect of this form to:

U.S. Department of the Interior, Bureau of Land Management (1004-0073), Bureau Information Collection Clearance Officer (WO-630), 1849 C Street, N.W., Mail Stop 401 LS, Washington, D.C. 20240.

(Form 3440-1, page 3)