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Notice of Intent III IIIIIIIII"~I'll i L ~~ ~~. - sss d Operations JAN09 19Q' 110(c1 Annual Report Permittee Name: Harold 8randstadt Mined land Permit No: M-86-004 Reclamation Dit?sir Operation Name: Brandstadt Rock Pit Anniversary Date: 01/24/91 Total: E50.00 (Due on your Anniversary Date) Please return this Annual Report form with your completed Map** and a check or money order for annual fees due, payable to the Mined Land Reclamation Division, 1313 Sherman Street, Room 215, Denver, Colorado 80203. 1. Has your mine been granted TEMPORARY CESSATION STATUS? YES NO Does your mine have INTERMITTENT USE STATUS during the year? YES NO 2. * Total acres affected during the report year: C7 3. * Total acres reclaimed for the report year: Q 4. * Total acres in various stages of reclamation: a. 8ackfilled: ~ d. Topsoil replaced: ~ b. Graded: ~ Average topsoil thickness c. Seeded: ~~ replaced: List species seeded & seeding rate for report year on back 5. * The type and approximate quantity of fertilizers, organic material or soil conditioners used for the report year: 6. * Estimated total acres to be affected in the next report year; O * Please show the location of the acreage for items 2 - 6 on your map. The map shall be to a scale of not less than 100 feet to the inch and not more than 660 feet to the inch. Indicate the phases of the reclamation that which have been completed, correlated with your timetable. ** NOTE: If there have not been any changes since the last annual report and you previously submitted a map which correctly depicts the current acreage in items 2 through 6, then a new map is unnecessary. However, you must state this fact in your current annual report. Signature: ~i~~~~,° L.__~ c..l~ Date: / - ~- 9/ Please type or print current contact name, address, and phone number below: / Contact Name: /~Q r~/d ~r~.~~sT~/` P ne: (,jo3 1 f~; y-N/S9 ,// Address: T ~o yo ~' ~t a cs.~ /~G'. /'cl ~n/A. QiL// al / ~~a~ ~~~