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FiECEIVEU <br />,: <br />Annual Reclamation Report <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 rot 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: (7. C, l`,,,a/ M.NS ~.2 Permit No.: C' - ~0-- 002. <br />Street Address: ~ OS Y C ~ 7 3U <br />City: ~ u.u N~S~./ ,Colorado Zip Code: S~/ 23 C) <br />This report covers calendar year: 199 <br />Please Note: <br />If :his 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:_%/~~~~~ Date: J`-lr ` 9 / <br />MAY y 1994 <br />Di;icicn ct PAiner2!s d Gec~cny <br />III IIIIIIIIIIIII III <br />RPP/rpp/arpfortn.sam <br />