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,,>-.. .:. _._ u.S. DEr•NRTtnEr.T o~ Tilt u,t ~~.•_,r-. - , <br />' •~:='- : -_ O`tlce of Surer r I:~Inino -.'!: r•.-r• -: - a r- <br /> ' COAL PnODUCT1OrJ AND RECLAMATION FEE REPORT - <br /> E7 _ <br />19_ <br />,•v - ,:_-....`_.- <br />'~' :• . <br />~' . <br />-- <br />= RE ADnaSiHUCT70r:SSFrORECOMPL`7ua_TNISFpFlr.•- ---- .-.~,~,~:: ,~~:',~ <br />~ <br />C ~ -t ::~~ .. <br />' <br />'} - <br />_ <br />-,~ 11 ncp::ntcC in lorrnation is ins sect of mrun ~ <br />I u c ma e cr.. recl~n n; of s.. <br />_ <br />-i~;.~ ~,...~..~_~ <br />__: l1_~?':•} - adrnlons m nom 14 only. Do not carne in Hems 3 12. °-~v,~_.. ^~_b: c• <br />2 f.Sa:Y "Y." m the box 13a State Perms Number <br />i1 fvst report C I <br />L_ 3b CxpiraUOn Dalr <br />Name ofOnera'oi GTj(130L[, <br />TRin'.lld(t nA`1N f411:IGfi INC <br />]9-:~~ <br />_t nL'LD <br />rJieihn AddrCS --_.._.._ .. __. _._ -. _. .__-_ ._ <br />~PD kDY. 7H~ 11TH it.wRI Y._dGDkE_Y <br />'C ~ State TiP Code <br />~Tlr~It:l?tD CO b10R:' <br />i4 fJrinc fD I~umLer' ~. s <br />o5D3Cbb OP frlri ;; <br />- L-- <br />Namr~od Fer mittse -~ .r. <br />- ~ ;* . <br />_ ^ t. <br />r__ ________ ,, <br />Mailing Address ------- ~ -:~- <br />City -- ,---rState f~itl 47 <br />- ,•i <br />.___ _-__-- - ^_r <br />LOCATION OF MINE _. w-'~•,-;~ <br />~• <br />~ rvamc of rrmr <br />OEL ~SUt "7n": <br />t. Name o1 Comas Pe,son <br />County (!71 Stale DB <br />LAS 4F11 Hk`: CG __...-... <br />-- -- - -------.--- _ UOU 000-OD00 - <br />~-^~s~.=.:~~».. T3 PFlODl1CTION AND FEF C(iMRI]TATI(~N <br />IU rv edrell r/own. r', <br />T ,'•x <br />ion a.n dior. >>lb'-. -~~ <br />~'' r., <br />,A. _'.~..... <br />..,,~ ... .ie :.. <br /> <br /> <br />Coal <br /> <br />! <br />l <br />Mining Method <br /> <br />(b1 --~ Number of Tons Fee Pe4 ~Tom~ ~ ~ =.. 1...,.. °' <br />~ _ '•~ .r -~ - `-~~a ~~:~~~ <br /> <br />-- Cd <br />Subject to the Fee Standa rcenYaee ~ =T~11-dcy' <br />~ <br />a ----- I . <br />Icl -_ idi' t ~ lei ~'• ----~- `- <br /> <br /> <br />h <br />i Surface ~ 17 i 649.04 x 35 tents .or cents=5 .. 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No.~~, ~ ir':~ .. ,__ <br />eta ~ ' ~di° :'s <br /> Action F ' ~ ~Trans'stuon'tJd; Acco:rr•.; <br />Jy~ ~ <br /> ~ <br /> --. f T I J ~ <br />~ <br /> ' t• ;:.RBI120080^ t,'.0.4.: <br />, Z~ '~ <br /> <br />1 <br />_ - <br />~ ` <br />~ <br />Paniai Pay. ' FOBFC'esp -i <br />. - R~7;'10 '-'~ <br />r <br />~ ~~ <br /> <br /> <br />IPIEASF 17R)lE •':I4:L ID D5D3066 G7 5' <br />-. <br />. <br />f, -. i~. <br />- <br />"ov't'Code'. '..:~,~ ~~';:.j~(=~~ <br />~ <br />OA' YOUh LNECK ---- - -- <br />+ - eceipt Gode1 ~.. <br />-. <br />- <br />- Call the toll tree nunlUer (8001 251 -3 302 -if you have any prohlern'v:ati <br />th~cf <br />~t] <br />. <br />. <br />National Trrll Frey. Number or any other problem regarding the rr•ci-emalion {ee_ <br />- <br />---- <br />~r°'~ -'-• y^" 16. CERTIFICATION "<~~N,'J> ==`"~-~' - <br />r~ ,, ~ w: _ <br />- _ S'a. -K_ ~.H~ <br />ia.1 I HEREBY CERTIFY that the st alemenu maL.e herein {d.1 SlfbsrY it?cQ and"Sru[tm~d Me thls_, _9ey; ~='' <br />are true, complete, and correct to the best of my know ~y,. ,n .-~. ~ts <br />t~p Q!esence of ~= <br />~b ~ ~~ <br />^ <br />, <br />led and belief, and are made in ood faith. <br />her r. m+:r m +eyw uny pesos, w:yu:mu u: uc c., e..vw u: - _ ~ .,: <br />~ <br />~ ..~:.- <br />I director, on behalf of the operztor, <br />(pnm in ink or 7ypel or the operator ~- <br />~ / <br />~J "r^ yy~ <br />~ ~ ( Lt <br />' <br />- - <br />~ <br />~~ ~: •.%~: <br />~ "7~ <br /> <br />, <br /> <br />' Na Eartlett <br />~ <br />i } I 'r <br />per <br />~~4_LP <br />`~i x"-34' 't~r~1.7~Tri ~ <br />t ~ <br />r i <br />F~' <br />w <br />- <br />-- --------------~ <br />le.) S~onzture ~ ~ <br />~----- <br />~Dzte _ t <br />= h'OT F. P. `{,.PUBLIC i0 -=tS ~ > <br />-~r-t <br />I <br />~ /~Cl~ ~°t7Cc~~ <br />~ - - -- - -- / <br />~/g"1- <br />-- <br />- <br />- F.M1y Comfninlon Ezpues~ 79 __'_ <br />- .: .., <br />-- <br />--- Tn~r 39115 C Sin ion 1737 p~u'ades rhar Y <br />any p+aon c'po~.:e off rter, r.c~nt o, dnrnor, on bthall of a cpsl m,ne o.:c: ato w c in n. ri.yjft <br />1 -. any raise s:aie:Hem, ~en'ra~n;ar:on <br />': fnall <br />n <br />~ <br />n <br />b <br />n <br />v <br />b <br />~ <br />h w rc: tlfrcanun. o- t. r,~.,•n~IV r <br />d b <br />f <br />f <br />~ <br />h <br />' alh tp r..; ^e znl' sr at e:*, r:nt. ~e;n r=:.: at,o:. o: cr:'~i`::' ..n <br />. <br />et <br />r ~r~-...re- <br />1 <br />. <br />, <br />p_ <br />. upo <br />,YC <br />co <br />rt <br />o <br />:h <br />o c. n ~: mp <br />y z <br />~ a o <br />e : <br />~e <br />.:,:r _ <br />_ <br />U.OSJ, o: by imP~ mnnnien: <br />4~ nr.: -,a t5z:• u' i . e_: e• ~r <br /> <br />