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<br />COAL PRODUCTION AND RECLAMAT
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<br />READ INSTRUCTIONS BEFORE COMPLETt1riG , RIS FARM '
<br />If preprinted information is incorrect or missing pralG~'cprrectkiris or "
<br />additions in item 14 only. Do noPwrite in iteml;3-12:' '
<br />2. Mork "K" in the box
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<br />"f 3a. State Permit Number Yy°53 ~ i, 1rl ~~'~
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<br />I5. Name of Operator
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<br />13. PRODUCTION AND FEE COMB 'Q,4A74 ~,."`, ;'.~:_' ,:
<br />Coal Mining Method Number of Tons ~ ~ " ~2r:~ ~N' '•~-~<,„";,; ,''ti;,: 3,' t
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<br />16. CERTIFICATIQN ': ; <'-
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<br />a.l "1 HEREBY CERTIFY that the statements make herein ;,'.Id.)- ~I•bad;i
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<br />(6.1 Name o5 reporting person, corporate officer, agent or '• „- ~ '. t.,I; '". ' '; t,:,4w." +;''r~~" 4'~`!(`r~ri'~
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<br />director, on behalf of the operator, or the apgrator
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<br />Title 30 U. ~. C. Section 132 provides that env person, corporara oMi ew. open( or dir8ewr: on
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<br />TAke3 any ra15e StatemEer, representation or
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