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I r~o•o.r]t,r ~a~ U.S. DEPARTPAEWT OF THE INTERIOR ~ Cete nna Gu:'t cr Er.O•n6,
<br />e 19!K67~F.(ri9i1 Office of Surfar.r IJllning •~ .D March 35 ' ~TJune 90"
<br />Erp,": :l~J7J1 CUAL PRODUCTION AND RECLAMATION FEE REPORT ~ r_76=_ptemner.,O~.~Decrmber3l
<br />79_ B ]
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<br />READ INSTRUCTIONS BF °ORE COMPLETING THIS FORM
<br />H pieprintCA in lOr mdllDn i; ~nCUiied Dr mi5tlnq mat.O ~GUireCt~nnS Or
<br />additions in item 14 only Do not write m items 3 12.
<br />" in the box ~a. State permit Number 79 _ _, j
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<br />2 . , ~ 14. Mine ID Tllumt>e{~~~:, '~ •r ~.
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<br />5 Na foem Opera~.or D 50 3 D L E 6. Name ~01 Permiriee ~ -r ~;R ', ~'
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<br />Marling Addres. - _ - ----~ - ---- - ~ ~ Mailing A,ldrecr --~-----
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<br />Ii~ir:]'tAD State CD Zi~ioda; __ _
<br />Clty T rate Izrg~.gpp
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<br />r LOCATION OF MINE ,. "; _ ~ . ,~:. :'~
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<br />i7. Name o1 Mlrie 8. County 1!71 rate ~
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<br />B 1D. Nearest' own! r: ~-~;-.'=~
<br />DEL ~GUA rln~r- LAS 4P~)r',A`: ~ CG "'"
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<br />i 1. Name o1 Comad Person Telephone-7Jurytber ~ -~ f ~, 2.'~tn tari`Reserv~lion andlbr ~f l¢e,
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<br />'~^~' -= 13. PAODUCTION AND FEE COMRUTATION'. ~ _
<br />.t>.-r~~e~=xt s s
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<br />Coal Mining Method Number of TTons ~ ~ , .: 'FQe der ~Tom~ . ~ ~
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<br />la) Ib) Subject to the Fee Standa.C~''' rce+ttage .r
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<br />Surface 17 649.04 x
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<br />352ents ., or
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<br />.. t;>4+17.7 ~ ~a.
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<br />Anthracite. .:.
<br />..~.y ; ~ ,f, y,
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<br />Bituminous, or
<br />Subblwminous - ~
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<br />$
<br />Underground i tb cents. p r
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<br />x 10 cents~;~ }• =S `r ~!~~ ~;~+„ ~1 ~`:
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<br />Total Fee To Be Paid No Later Than Thirty (3D) Days Afler The Fnd ~ :~'t.. l~ "•..
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<br />Of The Calendar Quarter
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<br />14. Corrections or Additions (Identify by Item Number, , •~~ ';!•'' "r"•.:? `l~ t "8+~
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<br />Oh YUU~ C'aECK eceipt~Cod ~ ..
<br />Call the toll tree nunlLer (800) 251 -3 3U2 it you hate any problem with-th~s##0/i
<br />National Tnll Free Number or any other problem regarding the n:ciamation {gee. .,
<br />•- ~'t ----_ 16.CERTIFICATION---~-- _-" _-- .,:*
<br />(a.1 I HEREBY CERTIFY that the statements make herein (d.l'Siftistx i4cQ.gnd-Sworn rd Me this - De'y;• rs'
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<br />are true, complete, and correct to the best of m know
<br />y~ ~' a.0'~~~in, rite W_,esence of --~ , .',: ~~i. .
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<br />ledge and belief, and are made in good faith. .
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<br />~Ib.l Name o1 re Porting person, corporate officer, ao°nt or ;. ~. ,
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<br />director, on behalf of the operator, or the operator
<br />ant in ink or type)
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<br />Date
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<br />Ic "NOT F:R`(..PUBLIC jQ-~S'~:~<
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<br />~J7~ta.. ~-Z,r~f~,~ ~f~/~~ My ComfiisSion Expires: 19 _ :;`~
<br />r True 30 U S.C Sen,on 123? p,o r,tl es that anY pA~son, to~po, ere once r, anent m tluea or, on benan of a coal mme operas o~ rwo x~mn ryyp~~
<br />I main any fal>e s~at¢ment, ,ep~esentat,on m cenit,caupn, o- 4ra.nn~ly fans to m, :e anY st atemept, rap, menta4or. or certiGaa t•on es
<br />M;. sec non snail, uunn cc•nc.nlon. be punish ed by a 1me of ,. o: mo•e tha7n 510,000, or by imps sonmem for nm mo,e than one Yea.' o' no's.
<br />r04'? OSe'. t rne.,feil I e.~m 63171 Oaobrr 19P0
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