20210720_Release_Request

DECEIVED
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/27699-11612 /
OPERATOR:
ADDRESS: /31 /goUcgJ�o✓ j�L >k/ JJJJSc/ �j�acy,fG
MINE NAME: 72% Z�—
PERMIT NO.: /© ^ C/rf
COUNTY:
TOTAL ACRES RECLAIMED:
TAILINGS PONDS: C�2 STOCKPILES: d WASTEPILES: lJ
PROCESSING PLANT: ACTIVE MINE AREA: 2, z,
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. ` QD,
Signed ��< < woet-
Title
Date �' — 2(
9/03

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DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES RECEIVED
V ED
DIVISION OF ENERGY,MINERAL AND LAND RESOURCES
MINING PROGRAM �.
2018 Annual Reclamation Report
GENERAL INFORMATION
Legal Corporate/Owner Name: / A-^dl«
Site Name: ,n,GNrr9� �ii.�C �71--
Site Permit No: ��'9y Site Phone Number,if any:
Site Address(911 Address)Line 1:
Site Address Line 2:
City: —_ _— State:_-N(- ._—_ Zip Code: — County:
Facility Coordinates: Latitude: Longitude: - River Basin:
Responsible Official/A
uthorize Contact: Invoice Contact:
Name/Title: 4rw �/'d D 01v .� Check if same as Responsible Official/Authorized Contact :_✓
11
Mailing Address Line 1: Name Title:
fvi/Se O ZY9"
Mailing Address Line 2: Mailing Address Lined: —
City/State/Zip Code: Mailing Address Line 2:
Primary Phone Nil'p -I'V! No. city: State: Zip Code:
Secondary Phone No. Primary Phone No. Fax No.
Email Address: Secondary Phone No.
� � Email Address:
1. Is the site Active? !� Yes —1 No 3. Estimate land to be newly disturbed by mining in the 2018
calendar year. Acres
If mine is now inactive,when did mining stop? rr��I
Date:, 0/? Check here if no new acreage is to be affected in 2018:
ll I 4. List by category the total amount of disturbed and unreclaimed
Is this stoppage permanent? J Yes J No land present at this site at the end of the 2018 calendar year.
If yes,do you wish to have this mine site released from your (A) TAILINGS PONDS Acres
reclamation bond? El Yes J No (e) STOCK PILES Acres
(C) "WASTE PILES: © Acres
��1� (D) PLANT AREA Acres
2 2. Was new land affected in 2018? Yes -1 No (E) MINE EXCAVATION V,%L Acres
If yes,how much? l Acres
—Y1 TOTAL DISTURBED AREA AT SITE: Acres
u Is map on file current? Yes J No "Note:WASTE PILES should include overburden storage/disposal
If the map is not current,submit updated map showing areas and berms.
affected acreage.
5. State and describe the amount and type of reclamation carried out in 2017 calendar year:
Check here if no reclamation completed in 2018: ���
Signature of Responsible Official/Authorized Contact:
QJ� ,/ I Date: /
Print Name: .._/r 6L NC N.9ncv F'` Title: ft�Ni•C,L�; Fdr4 ,..

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