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r.pMn•en DV Ga_. U.S. DEPARTMENT Or THE INTERIOR 1. Ca'rnn a: Dcr c.+er Ennlr.y.~ ,
<br />otsonwla~ey: Otilce of Surface Mining f3Atelch 31 IUiu^i30:
<br />txp"`" o~o'~'I COAL PRODUCTION AND RECLAMATION FEE REPORT ~ .J Saptembe~ 30 CDeeln,lior ~31~
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<br />P.EAD INSTRUCTIONS RE FORE COMPLETING THIS FDRM
<br />If n~znnnted mlur mation is incor ect of missing make eorreetlons or
<br />addrions m item 14 only Do not writE in items 3 12.
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<br />r-- 3e State Permit Number 7•~~~3 ~
<br />2 Mark "X" in the box 4. Mine.lU ~bCG: •Ty. ~.:~~ ~-
<br />it 1irs1 ~epon r~-~ u~~ ~~
<br />l_,J 3b ExpnatrunDate onr~nn 0503.gb5 0?i;0~ ;'
<br />~5. Namc of OVeratot 05~30bS 6. Name o1 PermiRee 't' ;
<br />TRIF.IDAC nA9IFt f',Ir1I~G IrIC .i:-~ S.
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<br />A4ailing Address Mailing Address -~' ~ :"• '.. ~,
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<br />IPD HDi( 763 aTTt: iEP°.I I~AR7;+EY '.r(!r
<br />C,~y State Zi cc
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<br />~~ Clty IState Zr~~aaa
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<br />2
<br />51 ~ ~
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<br />LOCATION OF MINE ; ~ "~ ~'
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<br />7. Name of Mine 8. County ~7I 9. State 08 ~ 10. Nearesb•.vsvn ,~r.,~:'I :
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<br />DEE 4LUA '~TnE (d5 A^II,tAS
<br />_ ~ _ CO :r;' -"',_;<'~
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<br />11.~Name of Coraatt Parson. Televhona.Numbrr ~ ~~' 12. Irdltsrt:R~~'vatior,`and/gtF
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<br />• 000 ~OOO~OAS~.O y
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<br />13. PRODUCTION AND FEE COMRUTt4T10,JU -
<br />Coal I Mining Method Number of Tons :'..Fre Per Tqn `••'.,;.; •>;e+': '•'; I+T' T '=ti;~
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<br />le} Ibl Subject to the Fee tand Std • ;
<br />~' ercentege ;•
<br />~111k ~ ,; -, ~.~ •„~fs7~
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<br /> (c} fdl
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<br />Surface
<br />~-~Frf,$?.~.°• x
<br />35cen.Ts.,',. o L -'.
<br />r..~~- .e¢hls~:5. ~,''..i~~,~
<br />Y~.~~'1
<br />,nom .r a. R
<br />, v
<br />Anthracite, .
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<br />Bituminous, or -. ~
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<br />.ti. .~ '.. ~; •',,
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<br />Subbituminous Under round ~ ~~`9
<br />~15 GtnT5~' .
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<br />r ~ ~.~Hq}s°$ .:. ~, ~,'~' ~ - ~'ii "'1~"ty.
<br />
<br />Lignite ~ x 10 Centi~,r~~~'o - ~,~n(5~$ r ,• :,,~rl .:~r~; ¢{h.
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<br />Total Fee To Be Paid No L'eter Than Thirty (30) Days After The End ~ ~i;,^'.• - '~.; ~~
<br />' - .i''7.'1 ~ad:.:~?-' c•~ ? `s'
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<br />4
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<br />Ot The Calendar Quarter '
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<br />14. Corrections or Additions (identify by hem Number,
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<br />~ ~ ~i t', ~ •-~::+•_ -
<br />15.•OSM•Use ~OnJy
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<br />Attach~Sheet It More Space is Neededl~ ~ _
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<br /> D.T. No. ;:.; ~ r fie.. . , , _- jt1:
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<br /> Action .F ' ~ Yraristrction;No., ' . gcglilint ?•+~
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<br /> ParTial'F'ey.=~. ;~.i~ ~/Cash •
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<br />PLEASE ;;RITE '-:If+E ID 0503Db5 02 °' _
<br />Gov't b ;,,; ~ _ I r.: `j:ti' ~ • ~~ ~sat~°1 C~
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<br />DN Yr1UR CNECK ~
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<br />eceipiCo !rl: '.;: ,..: ..',<~ :'~3i>±'r`~
<br />Call the toll free number (600) 251'93D,Z''if ypu Fiava ens prt7ble ?3A,it1T tgfp
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<br />National Toll Free Number
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<br />or any other problem regardiny the reelaRiaTion~e: ! .; ~
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<br />~: 16. CERTIFICATION
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<br />(a.l I HEREBY CERTIFY that the statements make herein ..:(d.)aihrcrfbeQ and ~em to Me thla " ; -Da!!of.~:c.;
<br />are trur, complete, and correct to the best pt my know ~ ~ : ~~' -?9 [ `Yt a pre5erice of ~'~~• ~ ~ ;;:y ~'
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<br />ledge and belief, and are made in good faith. ~ ~ ^ ~
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<br />(b.) Name of rzporting person, corporate officer, agent or '. ~ ;a.. Fz~ ~e'7~•~t
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<br />dFr ector, on behalf of the operator, or the operator ^ {tee, _ , -
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<br />(Print m ink or type) 7CJC.Y~-
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<br />Expires:l9_g~ ~.:';~1:
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<br />Title 30, U. C Sea ion 173 p~ontlo that any paaon, torpor are otl icu, agent or dn8npr, on bwli". o~~ eoel,m~ne operelof r.tro Lnga,[rtslyy
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<br />m„+ee any ta.se st x,amem, rep: esen[anon or certiLCavon, or Anow,ngly tails m mxs:e ~y pnreme/ti, rapt esem afion of cendi¢au on ~e$,dkC
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<br />lof not rr. ure then one veal Ur ~4Js.,
<br />.n this senion shall, upon con.,;nion, be pu nishetl by a line of no, more than 510,OOQ 0~ by rma: ironinenl
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