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<br />Permittee Name: <br />Permit No: <br />Operation Name: <br />Anniversary Date <br />Total: <br />iii iiiiuiiniuiii <br />Notice of Int~~O(1) AnnualuReportng Operations ~,c~~^lv~D <br />M~93-030uckner JAN ~6 1994 <br />C, ; .,. <br />Crystaljack Mine - ,.~ <br />04/26/94 ~~~t° o <br />$75.00 (Due on your Anniversary Date> G,~.`yY <br />1. Has this mine been granted TEMPORARY CESSATION STATUS? <br />Does this mine operate MORE or LESS than 180 days per year? <br />2a. Financial Warranty: $ 2b. Permitted acreage: <br />3. Does this mine have a phased reclamation plan? <br />4. Total acres affected during the report year:* <br />5. Total acres reclaimed for the report year:* <br />YES NO <br />MORE LESS <br />YES NO <br />6. Total acres in various stages of reclamation:* <br />a. Backfilled: d. Topsoil replaced: <br />b. Graded: Average topsoil thickness <br />c. Seeded: replaced: <br />List species seeded & seeding <br />rate for report year on back <br />7 <br />8 <br />The type and approximate quantity of fertilizers, organic material or soil <br />conditioners used for the report year:* <br />Estimated total acres to be affected in the next report year:* <br />9. COMMENTS: <br />* Please show the location of the acreage for items <br />Indicate the phases of the reclamation which have been <br />your timetable. <br />** NOTE: If there have not been any changes since the <br />previously submitted a map which correctly depicts the <br />through 6, then a new map is unnecessary. However, th <br />Signature: <br />Date: <br />4 - 6 on your map**. <br />completed, correlated with <br />last annual report and you <br />current acreage in items 2 <br />is must be stated above. <br />Please type or print current contact name, mailing address, and phone number below: <br />Contact Name: <br />Company: <br />Address: <br />Federal Tax ID No. or Socia~ Security No.: <br />Phone: ( ) <br />~~a <br />