DMR Forms



 Below is a list of forms used by Mining and Reclamation.  These forms are not available on this site if they are on the EPermitting system.  Only the forms that are not currently on the EPermitting system are available.  If you have any questions regarding a specific form please contact the DMR Webmaster. 

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DESCRIPTION    

FORM #

LAST REVISION DATE

 ADVERTISEMENTS      
Inactive Status MR-14ADV  *eP

Feb-09

Intent to Prospect MR-3-AD  *eP

 Jan-07

Permit Release MR-7-AD  *eP

Aug-08

Permit Renewal MR-17-AD  *eP

 Oct-06

Permit Revision - Significant MR-4-PR-AD  *eP

Jul-08

Quarry Modification MR25M AD  *eP

Feb-11

Quarry Renewal MR18AD  *eP

Sep-06

Quarry Transfer, Assignment, or Sale MR-19Q-AD  *eP

Mar-07

Removal of Abandoned Coal Refuse Pile MR-21ADV  *eP

 Apr-99

Surface Mine App and NPDES MR-4 & 5 AD  *eP

 Feb-06

Surface Mine App only MR-4AD  *eP

 Feb-06

Surface Mine Application Re-advertisement MR-4- Advertisement  

 Feb-11

 APPLICATIONS      
Cease Operator Assignment MR-19N  

 Nov-03

Change of Owners/Controllers MR-19C  *eP

 Aug-07

Coal Ash Utilization  (Included in SMA, Section I) MR-36  *eP

 Jan-94

Dam Certificate MR-4D  *eP

 Oct-04

Inactive Status MR-14  *eP

 Feb-07

Incidental Coal Removal for Construction MR-4C  

 Aug-07

Merger/Name Change MR-19B  *eP

Aug-07

Operator Assignment MR-19  *eP

 Aug-07

Permit Renewal MR-17  *eP

 Feb-07

Permit Revision MR-4PR  *eP

 Jul-08

Prospect - Intent to MR-3  *eP

May-08

Quarry MR-25  *eP

 Aug-07

Quarry - Inactive Status MR-14Q  *eP

 Oct-01

Quarry - Modification MR-25M  *eP

Aug-00

Quarry - Renewal MR-18  *eP

 Sep-06

Reinstatement of a Permit MR-19R  *eP

May-08

Request for Endangered Species Consultation MR-27  

 Jan-10

Small Operator Assistance Program MR-30         

 Dec-02

State Historic Preservation Questionaire MR-SHPO

Sep-06

Surface Mine MR-4 *eP

Jul-08

Transfer, Assignment or Sale of Article 3 Permit    MR-19A *eP

Aug-07

Transfer, Assignment or Sale of Quarry Permit  MR-19Q                 *eP

 Aug-07

 BLASTING FORM#                              
Blast AD EB-38   April 2017
Blasting Fee Affidavit Affidavit   April 2017
Blast Log EB-37   April 2017
Blast Log Instructions EB-37 Instructions   March 2017
Blast Notification Letter EB-39   March 2017 
Blast Notification List EB-38A   March 2017
Pre-Blast Survey Request EB-39A   March 2017
Pre-Blast Survey Waiver EB-39B    March 2017
Pre-Blast Survey Affadavit EB-39C   July 2017
Pre-Blast Survey for County Clerk Filing EB-39D    March 2017
Pre-Blast Survey Form EB-40    April 2017
Pre-Blast Survey Inventory Form EB-41   April 2017
Section T - Blasting Plan- is a section the the SMA form    
 
 BONDING    FORM#    
Annual Bonding Progress Report                               MR-26          

 Sept-06

Certificate of Deposit Waiver Waiver - CD
Letter of Credit Letter of Credit
Letter of Assignment for Certificate of Deposit Assignment for CD
Mitigation Surety Bond Mit-Surety Bond

Nov-07

Option to Invest / W-9 Invest

Dec-12

Reclamation Surety Bond Bond  

 Jun-05

Self Bond Application Self Bond  

 Mar-98

Transfer of Performance Bond Transfer Bond     

 Jan-04

CHECKLISTS

     
Combining Quarry Permits MR-42  

 Sep-06

Groundwater Questionaire-Quarry MR-43  

 Sep-06

HazMat Evaluation and Inventory MR-45  

 Sep-06

Operator Assignment/Transfer,Assignment, or   Sale Checklist  MR-19CK  

Jul-17

 
Permit Renewal MR-17 CK  *eP

Mar-07

Prospecting Checklist MR-3 CK  *eP

May-08

Quarry Modifications MR-25 M-CK  *eP

 Sep-06

Quarry MR-19Q MR-19 Q-CK  *eP

Oct-07

Quarry Permit Application MR-25 CK  *eP

 Jun-09

Quarry Renewal MR-18CK  *eP

 Sep-09

Surface Mine Application MR4Checklist

Jan-07

 RELEASES

     
Final Planting MR-8

*eP

Sep-06

Final for Quarry MR-7Q  *eP

 Sep-08

Permittee Request for Release MR-7  *eP

 Jan-08

Special Use - Request MR-12  *eP

  Mar-05

REPORTS      
Quarry Quarterly Production MR-41Quarry Quarterly Production

 Sep-06


Quarry Revocation Report
MR-10q    Jan-18
MISCELLANEOUS      
Approved Persons MR-50

Sep-06

Certification of Drainage System MR-13

Dec-06

Certification of Excess Spoil and Valley Fill MR-13B  

 May-06

Request for Removal of Sediment Control Structure MR-13R    Oct-14
Progress Map Reporting MR-23

Feb-02

Certification of Operations Designed using Final AOC Guidance Document (Steep Slope Operations Only) MR-29  

 Aug-11

NPDES    
NPDES Advertisements NPDES-ADs

Aug-05

Cover - MR5 mr5cov  

 Jun-04

NPDES 19-A-ck - Checklist for NPDES Transfer and Advanced Approval NPDES 19A-ck

Jul-08

Instructions for Module 1 mod1inst  

 Jul-02

MR5 Module 1 - General Information mr5md1  *eP

 Jul-02

Instructions for Module 2 mod2inst  *eP

 Jul-98

MR5 Module 2 - Monitoring Information mr5md2  *eP

 Oct-07

Appendix A-3 - Module 2 Part - IV 47 crs 30a  *eP  
Instructions for Module 3 mod3inst  *eP

 Jul-98

MR985 Module 3 - Adjacent Surface/Ground Water mr5md3  *eP

 Jul-98

Instructions for Module 4 mod4inst  *eP

 Jul-98

MR5 Module 4 - Mineral Information mr5md4  *eP

 Jul-98

Instructions for Module 5 mod5inst  *eP

 Jul-98

MR5 Module 5 - Barrier Information mr5md5  *eP

 Jul-98

Instructions for Module 6 mod6inst  *eP

 Jul-98

MR5 Module 6 - Preperation/Stockpiling/Handling... mr5md6  *eP

 Jul-98

Instructions for Module 7 mod7inst  *eP

 Jul-98

MR5 Module 7 - Effluent Treatment mr5md7  *eP

 Jul-98

Instructions for Module 8 mod8inst  *eP

 Jul-98

MR5 Module 8 - Abandonment Plan mr5md8  *eP

 Jul-98

Instructions for Module 9 mod9inst  *eP

 May-07

MR5 Module9 - Sewage Material Disposal Facility mr5md9  *eP

 May-07

Instructions for Module 10 mod10ins  *eP

 Jul-98

MR5 Module 10 - Underground Disposal mr5mod10  *eP

 Jul-98

Instructions for Module 11 mod11ins  *eP

 Jul-02

MR5 Module 11 - Modification mr5mod11  *eP

 Oct-07

Instructions for Module 12 mod12ins  *eP

 Jul-08

MR5 Module 12 - Transfer Modification mr5mod12  *eP

 Jul-08

Instructions for Module 13 mod13ins  *eP

 Jul-98

MR5 Module 13 - Remining mr5mod13  *eP

 Jul-98

Instructions for Module 14 mod14inst  *eP

 Jul-98

MR5 Module 14 - Groundwater Protection Plan mr5mod14  *eP

 Jul-98

Instructions for Module 1R mod1rins  *eP

 Jul-98

MR5 Module 1R - Responsibility for Discharge from Others mr5md1r  *eP

 Jul-98

Instructions for MR5GT mr5gtinst *eP

Jul-98

MR5GT - Transfer of Groundwater Protection Plan mr5gt *eP

Jul-98

MR5CG - Alkaline Mine Drainage Application mr5cg

Aug-06

Alkaline Mine Drainage Application Advertisement mr-gp-1

May-07

Instructions for Fee Calculation Sheet Inst.Fee Cal
Worksheet for Fee Calculation Wksheet Fee Cal
Annual Rainfall by County Annual Rainfall
Drainage Component Table (Table 2-I-B_ Drainage Table
General Mitigation Plan Gen Mitigation Plan *eP

Nov-02

INDIVIDUAL STATE 401 CERTIFICATIONS FORMS (COAL/QUARRY)
Instructions to 401 Certification Form Inst 401 *eP

Mar-09

Application to 401 Certification Form w/advertisement Cert401 *eP

Mar-09

MITIGATION
Mitigation and Compensation Agreement Mit Agree

Jul-04

       


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