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Notice of Intent to Continue Mining Operations 112 Annual ~tZeport ~F(~FI\/Fh Permittee Name: Permit No: Farmers Bank of Brush M-80-135 SEP 3 0 Operation Name: Headley Farms* Anniversary Date: 10/07/94 •~iv~siun~„~„~,t~a,, Total: $550.00 (Due on your Anniversary Date) ,,~tlu~uyy 1. Has this mine been granted TEMPORARY CESSATION STATUS? YES NO Does this mi ne operate MORE or LESS than 180 days per year? MORE LESS 2. Does this mi ne have a phased reclamation plan? YES N 3. Permitted acreage: Ss acres 4. Total acres affected during the report year:* 1/2 acre 5. Total acres reclaimed for the report year:* -0- 6. Total acres in various stages of reclamation:' a. Backfilled: _0_ d. Topsoil replaced: _~_ b. Gradetl: -o- Average topsoil thickness replaced: _0_ c. Seedetl: -o- List species seeded & seeding rate for report year on back 7, The type and approximate quantity of fertilizers, organic material or soil conditioners used for the report year:* none used 8. Estimated total acres to be affected in the next report year:* two (2) 9. COMMENTS: There have been no changes since last report. Please refer to the map s,~bmitted in 1990 * Please show the location of the acreage for items 4 - 6 on your map**. Indicate the phases of the reclamation which have been completed, correlated with your Ttimetable. '* N~IE: 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 anew m/ap is unnecessary. However, you must state this fact above. Signature: ~'//C~// ~ Ddte: September 27. 1994 Mark A Jen e , VIce President Please type or print current contact name, mailing address, and phone number below: Contact Ndme: Mark A Jensen ~ Phone: (303 > 842-5101 COmpdny: The Farmers State Bank of Brush Address: P 0 Box 324 Brush Colorado 80723-0324 nQ,Q~ ~{/f~",~ yyy Federal Tax ID No. or Social Security No.: