Laserfiche WebLink
~ l Ui_?:. F,i ~''~KT Ui l;,'_ 1:. i.J,lUn ~ ~ ' <br />it fists;~.;:;,-:-~~ O'f~ce of Sur{act 1,<inigS '' ~. ."?~-1.'r.c~, ~l ...:~-.~.~~ l' - <br />E+n,•c: 5: D: 3' i r~. j .-: S('1ne~,t>c: ~'J:~.!ry t'S 3~.: <br />CO:,L Pi~ODUCTIOh AND RECLAMtCTIOfr FEE REYOR, ~ t6 .•.~ -. ,,.J,: ,-~'I <br /> <br />• <br />\. <br />.-.{~~~~-r„,; AFADINSTAUCTIOkSBEFOR=COtJ\PLETINGTH!SYJ:-iV. <br />i <br />t <br />>r <br />~~~ <br />6 '-^:~~.~1~r~,:,f~~~~ <br />` '~4~' f' `' <br />' <br />, <br />- N fie r <br />med ro <br />or mation is nicon ect o~ miuui <br />oruot <br />i~ p p gmakteo~ree <br />-•Fo-'~;; •s°: <br />,,_- <br />~ <br />-. ytr~;: ~ <br />c.y <br />. _~ : additions rn rtem 14 only, Do not write ill.it°mt 3 12,; ;r;:~,:; y;,r ~,.3_ <br />_ <br />_ <br />i ,.I y. -w;,r. <br />. <br />f 13a. State Permit Number , . ~ <br />Fhark "X" m the bo> <br />12 4. Mlnc 'Ip ~t6rrY_n tiA .~+_: <br />. <br />~ <br />~ ~ <br />' <br />. <br />( <br />i111rst ieoort I ~ ' ~ <br />3b. Er,pirat~on Date <br /> <br />~ - _ -, <br />,: i <br />:1ri: <br />'~ ~,.' ~ v',~ <br />4 <br />:; .5 r1 ?'; tr <br />~; iii{ '+~ <br />' <br />~' <br />I , <br />, <br />- <br />5. Neme of Gperator - ~ .Name o1 Permlttee +r i' ': ,-~; <br /> <br /> <br /> _ - _t~-. <br />Mailing Address Alailinq :Cddrets '•+. ~~ .-i`':i~'[t-~~-'~- ".'.: <br /> - <br />(State - Zip Code <br />Gijy -~ .. <br />(5TY _ <br />`..~ "JSjcfe-i.~_ - <br />•~ r'. -. .=it("~ ~~~ <br />~~+(s~rp3j <br />~ <br />" <br />T <br />t\lt a r Ij'r111 ` .. _ _ • , <br />: . <br />~... .. .+.~5.._.-'' <br />r` j <br />_ <br />~'~L. <br />iLCYi <br />r' .;i _ 9.64 <br />., _ 'frt.. :... 4Mrtgzl <br />- ,. LOCATION O~.~JI1NE~~ - .,._: :i.~:. _ rtl;:~,,i~_.::rt; -,~ <br />~ <br />j ; <br />me of Mine - B. Couiny '7 i ';° ':~ `State' _~')~ "•tc <br />7.'rr <br />-0 ~,IG•63reS: iwn:; 'ty~ <br />I <br />~ <br />, : <br />i ' <br /> <br />~ !{ <br />~, ~~~~-~~ - ~~C`-i-~ <br />11_}lame of~ContaR Person Teleotia'it }a;unber <br />:. <br />~,...:YFs ~.,... <br />.,„ <br />- tia~; tb~'--varr ;.t, ,, <br />- <br />, <br />.4,,:--~-: •:•=;~~z:~: <br />, <br />-. - <br />;..:.. i <br />. <br />tea:- ::~,., <br />=' <br />~ °~ ~ <br />~ <br />~ 13. PRODUCTION AND FEE COMPUS~4TiOTVr:"' <br />~'~-~'°- <br />.? -.~. =4 ~ <br />~~. <br />_ <br />~f <br />e ~ <br />~ <br />'- -~' <br />` ~~ <br />' <br />~- <br />i, <br />FP <br />3 <br />.'_ ~ <br />:._. <br />':Cagl ~ Mining Method Number of Tons ' , '. <br />- . <br />, _ <br />• 'T <br />S'•r'. <br />~ <br />~1 <br />:Standalij'.... dLagv .- <br />fir} (bl Subject to the Fee = : , ; -0o S_~ <br />}.y~ <br />" <br /> <br />.. <br />Anthracite; Surface <br />~ 't .'i~..1~ '.,y..'x°~'Szerjts: ..'ty <br />ar .~v ~:...,"• .;. .. r~..~,, r:,d~y~=~ <br />, ... ,., ;;.., ,: .-•,l„-„ •.r. <br />:: 1 ,f'y ~~'~!,-. i?'_ <br />Bituminous, or <br />SubSrturitinous <br />~~ <br />round <br />Under .I ').."i("L I.• -, `"r6: ., ~~~>N .,. ~:;. ., <br />v _z h .ce is ~ <br />o <br />~ ;'` <br />'c <br />5 0 ~r}r~~~Ci,. <br /> <br />`C <br />~ <br />~, try <br />`RO ..--».,-< ~~. ``-` <br />•-• <br />•~•' ~•~ 1: <br />'T <br />' <br />' <br />_ g _ <br />, ~ <br />. <br />. r , <br />ti ;, : , <br />_~.,. <br />_ <br />C;~ <br />.d <br />' ' <br />.-. , <br /> <br />~~ s'. <br />Ci to ~' <br />.:, '-_ ~~=_'_`'nU~ce~tt"'..'~~. <br />n <br />` .~ ... <br />.. ,. <br />, rY 1 <br />r~D~`t(.-'~ T? -dc. -, ..`. <br />q`. 5- <br />~: <br />y~~~ ~ <br />__ <br />•~ d$' <br />':n <br />f <br />: :'iR~ <br />` <br />V ;x <br />l; ., <br />L, .S <br />YE: 1~S~ <br />i14!~ <br />t~~~t y <br />.,•y <br />""~ <br />:~' <br />- 'r _ <br />_. <br />r <br />1 . <br />- <br />.,; .. <br />r _ <br />Todg1 ~ee~o 8e faidNo falter Than ThFrty l~l'Dar~c4her The Flid;r~~~ ;:A'hi. : e• i!r:•-' :+,~,. t •i'r F ' i... ,.a+r ,~ . <br />QS7TFieCdtendar4ra:YEi ' .~ .i,:er-. ,t.. ~_ ::_^_~. <br />~ <br />~~ <br />u , <br />~.-1~r.r.~ ,.73F_ ' <br />~ <br />ld~'LbrreCtions'or,9 ddi6ony lldmtity by .Item NurtSoBi.• 1 <br />'°` <br />}~~ ~ ~} a..'}r:@ ~u~.`.~q,y ;.c:" <br />~ <br />~ <br />~ <br />.,• .~.~ <br />r ,4.r' <br />t-. ~,,r~ <br />~ y <br />Specs is TSeededl. <br />=I <br />'At'tach heat Si rAore <br />: ''- e <br />~ <br />4'x"• <br />. - <br />.. ... <br />. <br />. cam- <br />) <br />1 <br />' <br />.- - - n: v. . <br />n <br />n _,.-.-J,~ <br />_~ <br />:.1 <br />` Anion ~'F ;.~ <br />TrariioFtaonitlo. y{n: `"` <br />i <br /> _ r <br />;n <br /> <br /> <br /> ~ <br />~ <br />.~- <br />- ~.. <br />, <br />.,, <br />.. ' - ~ if <br />pert i~LPyy~ ~ - :! . <br />FrJ$%GtiSfi ~ <br />.,_ y <br />:'. ;'~ ~Y~~,"J $'~-r•"~ <br />' <br />'r`j6~ <br />~ ov <br />.nd <br />e ~ ~~ <br />{{ <br />?'~~,':n: p,',. <br />]•c.~>'~ :iL r ~+j l:i . ~r 7, J:30F <br />G l <br />., <br />•r'p <br />i: 11~ -' : <br />. <br />.- <br />. <br />. <br />, <br /> <br /> <br />Call the toil free number-IB00) `•~~a'`=~'''~'~~•``ii' ' u:fiave an <br />~ <br />y prtib;e <br />~~~ <br />. <br />.. ., ... <br />~~: +'• <br />Nadionai Toll Free Number ~ ' `''" ""'' <br />dtng~~ rEC aitis;iori~ee.. <br />or any other problem regar . <br />` -~~`+l-~O-F .y~,Y, <br />..- • . <br />~ <br /># <br />:: <br />. <br />.. - ~ ~ r. - r .rc'\ ,, is * `ti, .. ; <br />. <br />. <br />, <br />'x.~ '~:,'1 <br />: <br />- <br />' j <br />..,i~ ~^ <br />. <br />=r ~3,-•.~=-;-: ~~ <br />.16. CERTIF1CA710N: } <br />;i <br />~- <br />~ <br />~ ~ <br />~ ~5~-.~~,-,~~,'+~ <br />_ <br />. <br />.~ <br />_ .. <br />- <br />a <br />. <br />(a;r_l-HEREBY CERTIFY that the statements make 'herein _ ''i'Tld,)_Su soribed~ td ~worr to <br />~ <br />` _ <br />Y <br />l~~e~i; "~'~~ t~-1„'y;,~` <br />~ \, "~ er .,,;'-, ~ 'e .-;,..; <br />~ ^ s.'• <br />-'are tiue, m lete, and cosec{ ~to the best of~m know ~ `" <br />mp Y ':I~ ~,_~~+:. 74~~~n.thE•p~esei~;~tof -'... 'r..~ <br />~ <br />d tei <br />d <br />h <br />~~ <br />: <br />• <br />`~~ <br />. ~... <br />.. <br />e in.goo <br />t <br />.' ledge and belie and are ma <br />-: '. r• <br />~,;. 'i ' <br />.;;,; ' - ~~. u <br />'~ ~ <br />'~i; ' <br />. <br />(b„L 1{'ame "of reposing arson, corporate offlcd7, a~Oent or -~~, '~ , '.. '~~=':.:~ ~. . <br />-',Cs _: :~'%;' <br />director, on br~ali 'c*f ~ the operator, or the iOperator a. f:'- `:^~ "- }' cSEAII <br />' - -' :.r~ <br />.. <br />i <br />' <br />~ <br />~ •' ~ ,:~!' ~':'__ <br />-t. <br />~ <br />~ <br />~ <br />_ .. <br />(print in <br />- ~ <br />nk br type) ~- <br />.., , <br />l:; _ <br />' <br />-- :[,- .97`,_2,. .. •: ., ~ .. .orlA.°i <br />: ~ -- ~D~ ate ~ ~~' .IJpTAflY PU <br />(c.)~$ipnawre BLIC ~yx~~. ;'jy•S'~"~ <br />_ <br />-. _.- ~.1:./. __ ,.. _ ._: '!:'y CC+rim:'~-U,''~Y.pi res" ~9.~s :'ee~t r~~ <br />77;1. 30 U 5 C rtiaon 7777 p: ov;der that eny Per LOn, co: PO: air ollicer e}r,l D~ eh K;7r, en t.y,Kl 01 2 r.-t~ n•.n[ wra+D'r•'_ in~Lr:{: <br />rt¢t.r enS''1'1r s'e:emwll, ~[p'P4 nl etion OI t[,:it is tr:iDn, D~ Lrro v.Vn71y leis 1D [*,p ~[F afYj L1lf L~•Tt, rl;~~.[T-E!CR CY <t'IiP_;•J7 r~-'1•L <br />'- 'u, fA,. .r: dor, shall uoon cDn:ia io n. be n.a nl:`ic: 6Y .line DI no: mope :hen $1 D,Di~D. o: tY imparx•-.[nr h' n~: me•.e rF.+~ o'.• ,z' o•l~ptt~ <br />_ _ __ _ _ ~ ;~F- _ ~-T i <br />t~h h' i-Bfl'•, =1" p. ~' 19•~111'~l~-.` ~ \ _ _"Y". <br />