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'
<br />Permittee Nawv:
<br />' Pei CnuC No.
<br />' OperaCiOn N:Ilnl':
<br />A:IIl1 VeC'Sat'y UaCe:
<br />Total:
<br />~:v: ~ ~. , ~ ~:: ~i.. ~ ~ ,u~,nc
<br />1. a. Fe rmicced acre-.,,ye:
<br />2
<br />},
<br />d.
<br />c,
<br />6.
<br />7.
<br />}:. 8.
<br />4
<br />10,
<br />11.
<br />;, t,. ~~ Gw u'.::,oii C.~41K lVCe U:. r
<br />, curly :^t r. V: t
<br />~ ~ ''C~~ ia. Coca', ~~_„,::e :a.::e is ;reared:
<br />Has this mine beer, yranc~<1 ":'G!•I PO kd1. R.'! CES'SA'!':G:d :.':'A'CUS%
<br />Does this mane o}:_. aCr _. .ASS t~~.~r ~ e!a~s C>cr year%
<br />Dees chts mine have a p ;~:-d r: ~~.,:.~ ~~+.~'
<br />`focal acres affec~e..u du:: _.~~ .rpv:•_ :.,~,::
<br />Total acres r©c/ar..ed fo, the ~crt ....
<br />Total number of ac:~~~s in toC~sosl replacemer.c stayer
<br />a. Average thickness o'-~ copsotl replaced:
<br />'!'Deal nunJ~er of aCri=s serUe~:!.
<br />a. t,ise spectea .. y.,~ded 4 ., _~_ei::.y race .,.. tc~lr..: ':. yt~ur ~.: back
<br />Foe non-phased ope:. :,bons prow da dat,_~ :r.c race. n. :erased:
<br />a. Date rec lamauor. beyan:
<br />The type and approx_:nace c~:anu cy of fertilizers
<br />conditioners' used for th,e rel~orc year:' ~_
<br />YES
<br />QORE LESS
<br />YES , NQ.
<br />.,.. ''r;
<br />7^^
<br />Oryanl.C and C8r1a1 Or 5011
<br />Estimacad coral acres co be atiecced in the ne>;c report year:' ~ ~~ ,
<br />COMMENTS: ~ ~ -~
<br />* Flease show the 1ocs,cicn of the acre.,ye for items 4 - 6 on your maD"~ Indicat0`~'`"
<br />the phases of the rat Lamar: on wit: ci: nave beer: co;r~7.ectci. corre:ated o,i t:^, your ti[netpbl8 ~'"'~"'~
<br />';yk,
<br />For Ahased operations shot: ;laces e::tr-~cc:on ceased ar,ci acres r_cla^,ation.beyan. ~=.~_:,~rx ;b .,;
<br />~~f•.
<br />._ ,.. .«%
<br />** NOTE: If there have nor been ar.y cnanyes si.^.ce :;:e lu5c •~...,.:-~! repcrc and yoU '.
<br />previously suouiitted a map :r;nici: rc,_recc ly d~piccs the current ar_reaye in kerns 2 chroUgl3:'r
<br />6, Chen a new map u nec~»sary. ..;;:ever, chic muse be stated above. _ ~~~~
<br />-tn:
<br />t ni.:
<br />~.t;>.
<br />Si4nacurr. :,,~..,.
<br />~~r
<br />Please type or print C!U~rrar.c cOntacc name, :~.atliny address, and pno.^.e nu;nber below: ,,"~,f,:
<br />Centaot Name: \~
<br />Company: ('~ \ ~_u ~.r-. c4
<br />Address : (`\~`,~ \~ c~ y~ C~~~Q
<br />Fhone: r '~1 "- Oq~ ~
<br />FhY. NU; " ~ 51
<br />:`.;
<br />~j `' ~ C
<br />Federal Tax ID No. or Soc.ai Seccr:c,• :~:o.: C~ ~~_yyC~//r~, ~`,,~~
<br />r1Cli ~' M ~®
<br />JAN i 9 2006
<br />~,.
<br />~'. ": 6:... '.
<br />~' .
<br />. ! 9' ' ~, ...,.may
<br />u' ~ Zr`~')X91
<br />
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