Utah Department of Natural Resources
Division of Oil, Gas and Mining
1594 West North Temple - Suite 1210, Salt Lake City UT 84116
Box 145801, Salt Lake City UT 84114-5801
Telephone: (801) 538-5342
January 1, 2018 to December 31, 2018

The information required in this form is based on provisions of the Mined Land Reclamation Act, Title 40-8, and rule R647-3-117 under the Utah Minerals Regulatory Program. It is due January 31 of each year.

Please note: Large mining permits beginning with M require separate form.

Mine Permit Number: *
i. e. (S0123456)
Mine Name: *
Name of Operator/Permitte: *
Note: If Operator's address, company representative and/or phone number have changed, submit replacement page(s) for the Notice of Intention together with form MR-REV available on the Division's web page at https://fs.ogm.utah.gov/PUB/MINES/Minerals_Related/FORMS/MR-REV-SMO_EXP.pdf
Amount of Ore or Product Mined: *
Please Specify Units: *
Ore Disposition. Discuss the location of produced ore (stockpiled, processed, heaped), processing methods (crushed/milled, concentrated, leached, etc.), nature of ore (acidic/deleterious, inert, etc.):
Amount of Waste Materials Moved: *
Please Specify Units: *
Waste Disposition. Discuss the location of waste disposed, disposal methods (dumps, tailings), and nature of waste (acidic/deleterious, inert, etc.):
Primary Commodities Produced *
Total disturbed area from previous reporting year? (in acres)
New disturbance created during current reporting year? (in acres) *
Total disturbed area at the end of this reporting year? (in acres) *
The total disturbed area includes reporting year and previous year disturbances minus areas of regrading and reseeding that have received approval for bond release. The total area should not be greater than the permitted/bonded acreage.
Areas regraded during the year? (in acres)
Areas of reclamation eligible for bond release.
Areas reseeded during the year? (in acres)
To apply for full or partial bond/site release submit form MR-SITE available at the Division's web page at https://fs.ogm.utah.gov/PUB/MINES/Minerals_Related/FORMS/MR-SITE.pdf
Provide a Map. Provide a map (preferred) and/or written evidence showing total 2018 disturbed areas, areas of reclamation, and location (disposition) of ore and waste: Max. file size 1 GB Max. Total of all Files 5GB
Provide Written Discription of total 2018 disturbed areas, areas of reclamation and location of ore and waste:
I certify that the information provided is true and correct to the best of my knowledge. *
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