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<br />~ R III Illllllllllll III <br />Notice of Intent to Continue Mining Operations SAP 0 2 1992 <br />112 Annual Report - <br />DIVIS,~ <br />Permittee Name: Farmers Bank of brush MINERALS a GEJ'~.~- <br />Permit No: M-80-135 <br />Operation Name: Headley Farms* <br />Anniversary Date: 10/07/92 <br />Total: $490.00 (Due on your Anniversary Date> <br />1. Has your mine been granted TEMPORARY CESSATION STATUS? YES NO <br />Does your mine operate MORE or LESS than 180 days per year? MORE LESS <br />2a. Financial Warranty: $20,000 Bond 2b. Permitted acreage: 53 Acres <br />3. Do you have a phased reclamation plan? YES NO <br />4. Total acres affected during the report year:* z Acre <br />S. Total acres reclaimed for the report year:* 0 <br />6. Total acres in various stages of reclamation:* <br />a. Backfilled: 0 d. Topsoil replaced: 0 <br />b. Graded: 0 Average topsoil thickness <br />c. Seeded: 0 replaced: 0 <br />List species seeded & seeding <br />rate for report year on back <br />7. The type and approximate quantity of fertilizers, organic material or soil <br />conditioners used for the report year:* None Used <br />8. Estimated total acres to be affected in the next report year:* 2 <br />9. COMMENTS: There have been no changes since the last report. <br />Please refer to the map submitted in 1990. <br />* Please show the location of the acreage for items 4 - 6 on your map**. <br />Indicate the phases of the reclamation which have been completed, correlated with <br />your TTtimetable. <br />** N~IE: If there have not been any changes since the last annual report and you <br />previously submitted a map which correctly depicts the current acreage in items 2 <br />through 6, then a new map is unnecessary. However, you must state this fact above. <br />Signature: ~~ Date: August 31, 1992 <br />Please type or print current contact name, mailin dress, and phone number below: <br />Contact Name: Mark Jensen Phone: (303) 842-5101 <br />Company: Farmers State Bank <br />Address: P 0 Box 324 <br />Brush CO 80723 ~~r'N <br />Federal Tax ID No. or Social Security No.: <br /> <br />