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" ~ .-- ~ III IIIIIIIIIIIIIIII ~ <br />Notice of Intent tc 9_ ... ... .., Jperations <br />110(2) Annual Report <br />~ 1 <br />Permittee Name: <br />Permit No: <br />Operation Name: <br />Anniversary Date <br />Total: <br />Ron Ebberts <br />M-80-038 <br />Disappointment Valle <br />10/01/91 <br />ti . ~.<9 ~ _ . . . <br />1?~T u ~ i^al <br />~Uiin~d Land <br />'ieclamation Division <br />$120.00 (Due on your Anniversary Date) <br />1. Has your mine been granted TEMPORARY CESSATION STATUS? <br />Does your mine operate MORE or LESS than 180 days per year? <br />2. Total acres affected during the report year:* <br />_ _ ~_. T9tal~.cres r~cl.aimed~nr_the report_year:* <br />4. Total acres in various stages of reclamation:* <br />a. Backfilled: d. <br />b. Graded: <br />c. Seeded: <br />List species seeded & seeding <br />rate for report year on back <br />YES NO <br />MORE LESS <br />Topsoil replaced: <br />Average topsoil thickness <br />replaced: <br />S. The type and approximate quantity of fertilizers, organic material or soil <br />conditioners used for the report year:* <br />6. Estimated total acres to be affected in the next report year:* <br />7. COMMENTS: ~L,s.~j~i,cP ~~. ,c//sJ.O .l~.~Jp/.C~. G) /l~~i~niir~~ii~ ~ <br />~Q-4-~ ~~Y/l . ~L. -u-GGC-~. Co ..O .~C.°GQ/-.~ GZ-C~l !~'v ~J 1p7J-~ ,L,~~Qir~' <br />Please show the location of the acreage for items 2 6 on your map <br />Indicate the phases of the reclamation which have been completed, correlated <br />with your timetable. <br />NOTE: If there have not been any changes since the last annual report and <br />you previously submitted a map which correctly depicts the current acreage in <br />items 2 through 6, then a new map is unnecessary. However, you must state this <br />fact above. <br />Signature: ~/1~,/ ~,~~,y Date: ~'- / -~5~- 9~ / <br />Please type or print currennt~contact name, address, and phone number below: / <br />Contact Name : D//h~Y,~Xa~ ~~_~- Phone : ( ~~.3) ~ ] ~ -,~ ~/ ~~ t/ <br />Company: ~1c-~ C`r~.~-r / <br />Address: ~~/ 2 CV <br />~, ~ti ~~ 8135 ~'~,~ <br />Federal Tax ID No. or Social Security No.: S ~ 1 ~~~~_ 1~,~ <br />