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ermittee Name: <br />Permit No: <br />Operation Name: <br />Anniversary Date <br />Total: <br />999 <br />Notice of Intent to Contirr'g Mining Operations .~ <br />110(2) Annual Report <br />R~CEIVE~J <br />Lakewood Brick & Tile Company <br />M-75-009 SEP 26 1995 <br />Doughty's Pit* <br />09/30/95 - ~ Dwisiun of Minerals 8 Geology <br />$225.00 (Due on your Anniversary Date <br /> <br />1. a. Permitted acreage: ~ b. County where mine is located: c./E-FFF2to~J <br />2. Has this mine been granted TEMPORARY CESSATION STATUS? YE:S NO <br />Does this mine operate MORE or LESS than 180 days per year? MORE LESS - <br />Do you extract MORE or LESS than 70,000 tons of mineral or <br />overburden a year? MORE LESS <br />3. Does this mine have a phased reclamation plan? YES NO <br />4. Total acres affected during the report year:* /S/.~• //~w~zaesvQE <br />5. Total acres reclaimed for the report year:* ~~ Ct/q n/Cx~ <br />6. Total acres in various stages of reclamation:* <br />a. Backfilled: -a - d. Topsoil replaced: - o . <br />b. Graded: -e~- Average topsoil thickness <br />c. Seeded: replaced: - ~ - <br />-° - <br />List species seeded & seeding <br />rate for report year on back <br />7. The type and approximate quantity of fertilizers, ~ganic material or soil <br />conditioners used for the report year:* ~,¢ <br />8. Estimated total acres to be affected in the next report year:* _ _ -o <br />9. COMMENTS: /~,et-wuon b~R~ck ilr7~iTENOS ro (~NT7N/E 7~~ <br />OP~"72.v rio~i sSiS ~c~GED_ cJL~ DR~/lec/Z N/~9 <br />* Please show the location of the acreage for items 4 - 6 on your mao**. <br />Indicate the phases of the reclamation which have been completed, correlated with <br />your timetable. <br />** NOTE: If there have not been any changes since the last annual repo-t 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 />Signature: Date: <br />Please ty a print current contac name, mailing address, and phone number below: <br />!~ % _ <br />Contact Name: ~,gmEs /T. /`7ua4~aY Phone: (303 > ~ 2:3B~ ~T313 <br />Company: .1, ~9,re w o0o H~Q icf <br />Address: 1325 4~.qy /5iT nnnnnn tVVt~AA////// (1 rn~ <br />CiiKr~.~9o0 Co co Q4oo 8c,,-z l~r 1'`J <br />D <br />Federal Tax ID No. or social Securi.r No.: `O~` <br />B}~'U2t~~785'0 <br />