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~ <br /> <br /> <br />` ' Notice of Intent III III III IIIIIIIIII g Operations <br />110~c~ nnnuar r<eporL <br />Permittee Name: <br />Permit No: <br />Operation Name: <br />Anniversary Date <br />Total: <br />Patrick L. Cugnini <br />M-86-061 <br />Cugnini Gravel Pit <br />07/21/91 <br /> <br />~-~~~~.IVECs <br />JJL 1 6 1991 <br />Mined wand <br />~.. amation Division <br />5120,00 (Due on your Anniversary Date) <br />1. Has your mine been granted TEMPORARY CESSATION STATUS? <br />Does your mine operate MORE or LESS than 180 days per year? <br />2. Total acres affected during the report year:* <br />3, Total acres reclaimed for the report year:* <br />4. Total acres in various stages of reclamation:* <br />a. Backfilled: d, <br />b. Graded: <br />c. Seeded: <br />List species seeded & seeding <br />rate for report year on back <br />YES NO <br />MORE LESS <br />I ~.cK ~ <br />Topsoil replaced: <br />Average topsoil thickness <br />replaced: <br />5. The type and approximate au antity of fertilizers, organic material or soil <br />conditioners used for the report year:* <br />6. Estimated total acres to be affected in the next report year:* ~ 3-C,~~ <br />7. COMMENTS: <br />* Please show the location of the acreage for items 2 - 6 on your map**. <br />Indicate the phases of the reclamation which have been completed, correlated <br />with your timetable. <br />NOTE: If there have not been any changes since the last annual report and <br />.you previously submitted a map which correctly depicts the current acreage in <br />items 2 through 6, then a new map is unnecessary, However, you must state this <br />fact above. <br />Signature: <br />Please type or print cu <br />Contact Name: <br />Company: <br />Address: <br />Phone: (303) a ~ x- ~.-~ DO <br /> <br />Federal Tax ID No. or Social Security No.: _rja C~ - ~ d ' d0~ <br />Date: '~- ~ ~ - Q <br />contact name, address, and phone number below: <br /> <br />~~al <br />VI <br />lD 7 `7 `r~ I r ~} i ~ t/ <br />l~ li rQ,~ ~ o Cn ~ 1.30 1 <br />