20230418_Release_Request

RELEASE REQUEST FORM
Instructions: Fill out this form if all mining has ceased, you have completed all of the
required reclamation work and you wish to be released from the conditions of your permit.
Retain the pink copy for your records and return the yellow and white copies to the Land
Quality Section Regional Office serving your area or to:
N. C. Department of Environment and Natural Resources
Land Quality Section
1612 Mail Service Center
Raleigh,NC 27699-1612
OPERATOR: 6-4eVG 61mmorts -
r1 WrN1ADDRESS: 8 Rd. NW . Ash, ( C 2'41.26
MINE NAME: Gimrncm WAO
PERMIT NO.: l0-35
COUNTY: lb1'wtsW i4i
TOTAL ACRES RECLAIMED:
TAILINGS PONDS: O STOCKPILES: O WASTEPILES: O
PROCESSING PLANT: O ACTIVE MINE AREA: (AdC{iYG
I have completed all of the required reclamation work at the above referenced site. I am
hereby requesting to be released from the conditions of this mining permit and that the
posted bond be returned to my attention.
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Signed 'y t/II !? 2N� )� to
RECEIVED
Title OW(1P.,r'
APR 18 2023
Date —03 25 LAND QUALITY SECTION
9/03

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