SEMI-ANNUAL SEEDING REPORT
State Form 50619 (R2 / 9-08) Form B-601
Indiana Department of Natural Resources Division of Reclamation
I,
, as the responsible official of
depose and say: ,
That we have seeded the area depicted on the accompanying map for Permit Number Mine or Pit .
The below listed area(s) were seeded during the period of:
Location
January 1 through June 30, Post-Mining Land Use
July 1 through December 31, 20
.
Acres
Species and Rate
Amendments and Rate
Total Acres See Attached Map
Signature Title Date
. . .
INSTRUCTIONS FOR COMPLETING SEMI-ANNUAL SEEDING REPORT State Form 50619/ Form B-601
The listings below correspond with the numbered blanks on the form. 1. 2. 3. 4. 5. 6. 7. 8. Name of responsible official Name of company Permanent Program Permit Number Mine or Pit Name Check applicable seeding period Last two numbers of year when seeded Location by section, township, range and county Number of acres per post-mining land use. (Include acreage of non-seeded areas such as roads, ditches, water impoundments, etc.) Indicate post-mining land use(s) Species and seeding rates sown or planted Soil amendments and rates applied; fertilizer, lime, etc. Signature of responsible official Title of responsible official Date the report was signed for submittal
9. 10. 11. 12. 13. 14.
State Form 50619/ Form B-601 must be accompanied by a map to include the following: A. B. C. D. The boundary of the area(s) as reported on State Form 50619/ Form B-601 The permit (bonded area) boundary Location of all reclaimed, non-seeded areas such as roads, ditches, water impoundments, etc. Location of all previously reported areas so that each new map will be a composite of all preceding submittals
SEMI-ANNUAL SEEDING REPORT
State Form 50619 (R2 / 9-08) Form B-601
Indiana Department of Natural Resources Division of Reclamation
DIVISION OF RECLAMATION DEPARTMENT OF NATURAL RESOURCES SEMI-ANNUAL SEEDING REPORT
I, say:
(1)
, as the responsible official of
(2)
depose and
That we have seeded the area depicted on the accompanying map for Permit Number Mine or Pit (4) .
(3) ,
The below listed area(s) were seeded during the period of: (5) January 1 through June 30, (6) (5)July 1 through December 31, 20 ( 6)
Location (7) (8)
Acres
Post-Mining Land Use (9)
Species and Rate (10)
Amendments and Rate (11)
Total Acres
___(12)___
See Attached Map
Signature Title Date
(12) (13) (14)