Energy, Mineral and Land Resources

` State of North Carolina

Environmental Quality

Energy, Mineral and Land Resources

ANNUAL RECLAMATION REPORT FOR 2016 CALENDAR YEAR

North Carolina General Statutes 74-55 and the Mining Regulations require that "The mine operator shall, by February 1 of each year during the life of the permitted operation, and within 30 days of completion or termination of mining on an area under permit, file with the Department a mining reclamation report on a form prescribed by the Department."

PLEASE PRINT OR TYPE

Name of Mine: County: Mining Permit No.:

Mining Permit Expiration Date: River Basin Name:

Name of Company/Owner on Permit Document:

Official Mailing Address:

City: Zip Code:

Telephone: ( ) Check if change of address or telephone:

1. If mine is now inactive, when did mining stop? Date:

Is this stoppage permanent? Yes No

If yes, do you wish to have this mine site released from your reclamation bond? ____ Yes ____ No

2. Was new land affected in 2016? ____ Yes ____ No

If yes, how much? acres

Is map on file current? Yes No

If not, submit updated map showing affected acreage.

3. Estimate land to be newly disturbed by mining in the 2017 calendar year: acres

Check here if no new acreage is to be affected in 2017:

*4. List by category the total amount of disturbed and unreclaimed land present at this site at the end of the 2016 calendar year.

(A) TAILINGS PONDS: acres (D) PLANT AREA: acres

(B) STOCK PILES: acres (E) MINE EXCAVATION: acres

(C) *WASTE PILES: acres TOTAL DISTURBED

AREA @ SITE: acres

*NOTE: WASTE PILES should include overburden storage/disposal areas and berms.

5. State and describe the amount and type of reclamation carried out in the 2016 calendar year:

Check here if no reclamation completed in 2016:

Signature of Company Officer/Owner:

Print Name:

Title:

Date:

*Complete and return by February 1, 2017 two copies of this form along with two copies of an updated mine map (see note below) for each permitted mining operation to:

Land Quality Section

NCDEQ

1612 Mail Service Center

Raleigh, NC 27699-1612

FAILURE TO FILE THIS FORM BY THE DATE SPECIFIED MAY RESULT IN THE ASSESSMENT OF CIVIL PENALTIES AND COULD RESULT IN THE REVOCATION OF YOUR MINING PERMIT. SHOULD YOU HAVE ANY QUESTIONS, PLEASE CALL (919) 707-9220.

NOTE: If your operation was idle in 2016, or no new acreage was affected by mining, and no areas were reclaimed in 2016, you do not have to send an updated mine map. Also, if you have completed a permit action since January 1, 2016 (which involved updating your mine map), you do not have to send an updated mine map. However, the blue report form must be completed for all mines under permit.

DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES

DIVISION OF ENERGY, MINERAL AND LAND RESOURCES

LAND QUALITY SECTION