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III IIIIIIIIIIIII III MAR 2 71995 <br />Annual Reclamation Re u. ~ 999 <br />Division of rviinerais s ~eoiogy <br />This form may be used by coal mines that have not disturbed acreage or <br />conducted reclamation activities during the past calendar year . Rule <br />2.04.13 requires that coal mines file an annual reclamation report covering <br />the previous calendar year, for all areas under bond. An Annual <br />Reclamation Report is due on the 15th of February of each year unless <br />another date is specified in the permit. <br />To use this form, your mine must meet the following criteria: <br />• has not disturbed additional acreage during the past calendar year. <br />• has not backfilled and graded during the past calendar year. <br />• has not topsoiled during the past calendar year. <br />• has not seeded, planted or augmented seeding or cultural practices <br />during the past calendar year. <br />If you meet the above criteria then the following information will be adequate for the <br />Annual Reclamation Report: <br />Permittee Name: 0. C. <br />Permit No.: C-BO-oo2 <br />Street Address: ~ns~ ~,,,,,,f,/ ~~,,,,~i ~~n <br />City: ~,,,,,,; ~,,,, r„ ,Colorado Zip Code: R> J3/j <br />This report covers calendar year: 199 4 <br />- Please Note: <br />If this mine has reclaimed acreage in the past, please attach to this form, a list of the <br />locations, number of acres and date of planting for all previously revegetated areas. <br />The permittee may provide additional monitoring information as required by the <br />approved permit. <br />Signature of Permittee:~~~11~ 1~.n/ Date: °. <br />RPP/rpp/arpfortn.sam <br />