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-~ • ~ <br />Notice of Intent to ~nfirhue Mining Operations <br />110(2) Annual Report <br />iii i i ii i ii ~ ii viii ~i~ <br />Permittee Name: Lazy A Corporation <br />Permit No: M-77-407 <br />Operation Name: Cedar Creek Pit <br />Anniversary Date: 01/30/92 <br />Total: $120.00 (Due on your Anniversary Date; <br />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 />~/~F! ' 1 ]c o.. <br />YES NO .~ <br />MORE ~LESS~ <br />Topsoil replaced: /i <br />Average topsoil tfickness <br />replaced: ~_ <br />5. The type and approximate quantity 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:' <br />7. COMMENTS: <br />* Please show the location of the acreage for items 2 - 6 on your crap**. <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 corre depicts the current acreage in <br />items 2 through 6, then a n ap is ecessary. However, you must state this <br />fact above. //~ <br />Signature: i"~ ~~~~/ Date: /~' /i s' <br />Please type or print current contact name, address, and phone number below <br />Contact Name: <br />Company: <br />Address: <br /> <br />Phone: (~;^r) ,.%r7~ :3'~ <br />~/ Wv ~"\ <br />J ~.~~, <br />Federal Tax ID No. or Social Security No.: may- //~ %S ! 5~d <br />