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• ~~~ ~~~~~~~~~~~~~ ~~~ R~r'EIVF~? <br />Annual Reclamation _ _ _ = 9_ _ ~ ~~ 0 5 1996 <br />Divlslon of Mlnera~s t, ~ ,.- -d7 <br />This form may be used by coal mines that have not disturbed acreage <br />or conducted reclamation activities during the past calendar year'. Rule <br />2.04.13 requires that coal mines file an annual reclamation report <br />covering the previous calendar year, for all areas under bond. An <br />Annual Reclamation Report is due on the 15th of February of each <br />year unless another date is specified in the permit. <br />To use this form, your mine must meet the following criteria: <br />a) has not disturbed additional acreage during the past calendar year. <br />b) has not bacl~'illed and graded during the past calendar year. <br />c) has not topsoiled during the past calendar year. <br />d) has not seeded, planted or augmented seeding or cultural practices during the past <br />calendar year. <br />If you meet the above criteria then the following information will be adequate for the <br />Annual Reclamation Report: <br />PermitteeName: NATio,~/AG il~n,~6 coALri cPermitNo.: C S/ 0 35 <br />• Street Addrrss: uv 2 v c .e ~ z v <br />City: tfE sPE~ ess ,Colorado Zip Code: b' 13 2 ~ <br />This report covers calendar year. 1995 <br />Please Note: <br />If this mine has reclaimed acreage in the past, please attach to this form, a list of the <br />locations, number of acres and date of planting for all previously revegetated areas. The <br />permittee may provide additional monitoring information as required by the approved <br />permit <br />Signature ofPermittee: <br />• <br />Date:'T /9 ~ <br />RPP/rpp/arptorm.nrp 2/11/92 <br />