2023_Annual Reclamation Report_79-03

Action History(UTC-05:00)
Submit by Anonymous User 8/22/2024 1:17:49 PM (Start)
Approve by Adam.Parr 8/30/2024 12:27:41 PM (ARR Review-79-03 Madison Pomona Mine)
• The task was assigned to DEMLR Mining ARR Team.The due date is:September 5,2024 5:00 PM
8/22/2024 1:17:58 PM
• Adam.Parr reassigned the task to Adam.Parr 8/28/2024 11:50:36 AM

2023 Annual Reclamation Report
Complete and submit by September 1,2024
N.C. Department of Environmental Quality-Division of Energy,Mineral,and Land Resources
GENERAL INFORMATION
Mining Permit No.(?)
79-03
Once the permit number is entered,click outside the field box to prompt more information to pre-populate
Release Date(If Applicable) Original Issued Date Mine Data Current as of:
03/29/1972 07/30/2024
Legal Corporate/Owner Name"
Pine Hall Brick Company,Inc.
Mine Name*
Madison Pomona Mine
Mine Address(You Must Enter)*
(The 911 Address)
Street Address
634 Lindsey Bridge Road
Address Line 2
City State/Province/Region
Madison NC
Postal/Zip Code
27025
County* River Basin*
Rockingham Roanoke
Dropdown list Dropdown list
County Prefix Code*
79
Variable available for repository routing
Facility Coordinates:
Latitude:* Longitude:
36.37580 -79.99640
Responsible Official/Authorized Contact Information:
Name and Title*
Geoffrey Roberson

Mailing Address*
PO Box 836Madison,NC 27025
Primary Phone No.* Secondary Phone No.
3365486007 [phone]
E-mail Address*
[e-mail]
Invoice Contact Information:
(Contact info from above is carried below-please revise if needed)
Name and Title*
Geoffrey Roberson
Mailing Address*
PO Box 836Madison,NC 27025
Primary Phone No.* Secondary Phone No.
3365486007
E-mail Address*
[e-mail]
Is the site Active?*
Yes No
If the mine is now inactive,when did mining stop?* Is this stoppage permanent?*
06/01/2018 Yes No
Is the map on file current?*
Yes No
Check here if no reclamation was completed in 2023
List by category the total amount of disturbed and unreclaimed land present at this site at the end of the 2023 calendar year:
Tailings Ponds* Stock Piles* Waste Piles*
1.0 5.0 0.0
Acres Acres Acres(WASTE PILES should include
overburden storage/disposal areas and
berms)
Plant Area* Mine Excavation* TOTAL DISTURBED AREA*
0.0 6.0 12.0
Acres Acres Acres(Calculated Sum)
Is there any other supplemental information you want to upload to submit with this report?
Must be.pdf format(Max size 100 MB each)

(If applicable)Please explain additional attachments that were uploaded:
Exact Date of Mining inactivity is not known by me. This is the date I started in this role
NEW DISTURBANCE ESTIMATES FOR 2024
Check here if no new acreage to be affected in 2024
Certification and Signature*
By checking the box and signing box below, I certify that:
• I have given true,accurate,and complete information on this Annual Reclamation Report form and in the uploaded map document(s);
• I agree that submission of this Annual Reclamation Report Upload form is a"transaction"subject to Chapter 66,Article 40 of the NC
General Statutes(the"Uniform Electronic Transactions Act');
• I agree to conduct this transaction by electronic means pursuant to Chapter 66,Article 40 of the NC General Statutes(the"Uniform
Electronic Transactions Act');
• I understand that an electronic signature on this form has the same legal effect and can be enforced in the same way as a written
signature;
• I intend to electronically sign and submit this Annual Reclamation Report form;AND
• I have the authority to submit this Annual Reclamation Report on behalf of this Mining Permittee.
Signature of Responsible Official/Authorized Contact:* Date*
08/22/2024
�.o�y�ecj�pl�t JO�IG
Type Name* Title*
Geoffrey Roberson Technical Services Director
Email Confirmation will be sent to:*
[e-mail],[e-mail]
Additional E-mail Contact for Confirmation(if desired)
This submission is associated with Business Process Instance ID 213770.