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ermittee Name: <br />Permit No: <br />Operation Name <br />Anniversary Date: <br />TOtdl: <br />~ IIIIIIIIII III ~ <br />111111 <br />Notice of Intent ..99s~l~e Mining Operations. <br />112 Annual fiebort <br />-~- <br />Rite Form Concrete dba Zigan <br />M83-84 <br />Snowstorm placer <br />~-28-9EQ 550.00 <br />~E~~,~~n <br />~ 04 199b <br />Dlvlslon of MinBrdl9 ~ Geology <br />(Due on your Anniversary Date) <br />1, a. Permitted acreage: 2b~0 b. County where mine is located:pa may, <br />2. Hae this mine been granted TEMPORARY CESSATION STATUS? YES NO <br />Does this mine operate MORE or LESS than 180 days per year? MORB LESS <br />3. Does this mine have a phased reclamation plan? YES NO <br />4. Total acres affected during the report year:+ ~ <br />5. Total acres reclaimed for the report year:+ n <br />6. Total number of acres in topsoil replacement stage: 9 <br />a. Average thickness of topsoil replaced: na <br />7. Total number of acres seeded: 0 <br />a. List species seeded ~ seeding rate for report year on back <br />8. For non-phased operations provide dates extraction ceased: <br />a. Date reclamation began: <br />9. ~ The type and approximate quantity of fertilizers, organic material or soil <br />conditioners used for the report year:+ <br />10. Estimated total acres to be affected in the next report year:+ ~ <br />11. COMMENTS: <br />acr age e <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 timetable. For phased operations show dates extraction ceased and dates <br />reclamation began. <br />*• NOTB: 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, this must be stated above. <br />t <br />Signature: 0l~0~ ~i.n Date: <br />Please type or pritxf ctlfrent contact name, mailing address, and phone number below: <br />Contact Name: <br />Phone: (393) y~11~^Q90 <br />FAX NO: ( ) <br />Company: <br />Inc. <br />Address: 10A00 F._ 124 Ave_ <br />Brighton, Co. 80601 <br />Federal Tax ID No. or Social Security No.: gq nonnnn, <br />