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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Cease Operator Assignment MR-19N  


Incidental Coal Removal for Construction MR-4C  


Request for Endangered Species Consultation MR-27  

 April 2020

Small Operator Assistance Program MR-30         


State Historic Preservation Questionaire MR-SHPO


 BLASTING FORM#                              
Blast AD EB-38   April 2017
Blasting Fee Affidavit Affidavit   April 2017
Blast Log EB-37   Nov 2019
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      
Annual Bonding Progress Report                               MR-26          


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


Option to Invest / W-9 Invest


Reclamation Surety Bond Bond  


Self Bond Application Self Bond  


Transfer of Performance Bond Transfer Bond    


Combining Quarry Permits MR-42  


Groundwater Questionaire-Quarry MR-43  


HazMat Evaluation and Inventory MR-45  


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


Roads and Ancillary Facilities Checklist

Oct - 18
Quarry Quarterly Production MR-41Quarry Quarterly Production


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


Certification of Drainage System MR-13


Certification of Excess Spoil and Valley Fill MR-13B  


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


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


NPDES Advertisements NPDES-ADs


Cover - MR5 mr5cov  


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


MR5CG - Alkaline Mine Drainage Application mr5cg


Alkaline Mine Drainage Application Advertisement mr-gp-1


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
Reissuance Non-Slurry Application Mar-2019
New Non-Slurry Application     Aug-2018     
5G30 Mine Water Transfer Application      Sept-2018
UIC Annual Report     Nov-2018 
Permit Application for Slurry Injection      Jul-2019
Modification Application     Feb-2020 
Transfer Application      Feb-2020