Form MRD-5 "Certificate of Compliance" - Mississippi

What Is Form MRD-5?

This is a legal form that was released by the Mississippi Department of Environmental Quality - a government authority operating within Mississippi. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on November 1, 2002;
  • The latest edition provided by the Mississippi Department of Environmental Quality;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form MRD-5 by clicking the link below or browse more documents and templates provided by the Mississippi Department of Environmental Quality.

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Download Form MRD-5 "Certificate of Compliance" - Mississippi

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MISSISSIPPI DEPARTMENT OF ENVIRONMENTAL QUALITY
OFFICE OF GEOLOGY
Mining and Reclamation Division
P. O. Box 2279
Jackson, Mississippi 39225-2279
(601) 961-5515
CERTIFICATE OF COMPLIANCE
Operator’s Telephone No. _____________________
TO:
FROM:
KEN McCARLEY, Division Director, Mining and Reclamation Division
DATE:
SUBJECT:
Permit Number:
Anniversary Date:
Acres in Permit:
In compliance with the Mississippi Surface Mining and Reclamation Rules and Regulations, you must
complete and return this form to the Office of Geology, with the $25.00 annual fee, no later than
____________________________________________.
The undersigned does hereby declare that the above named operator is conducting a surface mining
operation at the indicated mine location and under the indicated permit, is abiding by the provisions of the
Mississippi Surface Mining and Reclamation Act and the Mississippi Surface Mining and Reclamation
Rules and Regulations, and is following the mining and reclamation plans approved by the Department of
Environmental Quality, Office of Geology, for said operation.
_____________________________________________
Operator
Date: ___________________________
By _____________________________________________
Signature
_____________________________________________
Official Position
Form MRD-5
rev. 11/02
MISSISSIPPI DEPARTMENT OF ENVIRONMENTAL QUALITY
OFFICE OF GEOLOGY
Mining and Reclamation Division
P. O. Box 2279
Jackson, Mississippi 39225-2279
(601) 961-5515
CERTIFICATE OF COMPLIANCE
Operator’s Telephone No. _____________________
TO:
FROM:
KEN McCARLEY, Division Director, Mining and Reclamation Division
DATE:
SUBJECT:
Permit Number:
Anniversary Date:
Acres in Permit:
In compliance with the Mississippi Surface Mining and Reclamation Rules and Regulations, you must
complete and return this form to the Office of Geology, with the $25.00 annual fee, no later than
____________________________________________.
The undersigned does hereby declare that the above named operator is conducting a surface mining
operation at the indicated mine location and under the indicated permit, is abiding by the provisions of the
Mississippi Surface Mining and Reclamation Act and the Mississippi Surface Mining and Reclamation
Rules and Regulations, and is following the mining and reclamation plans approved by the Department of
Environmental Quality, Office of Geology, for said operation.
_____________________________________________
Operator
Date: ___________________________
By _____________________________________________
Signature
_____________________________________________
Official Position
Form MRD-5
rev. 11/02
ACKNOWLEDGMENT
STATE OF __________________________
COUNTY OF ________________________
PERSONALLY APPEARED before me the within named _____________________________________
who stated that he is _____________________________ of ____________________________________
Title
_____________________________________________________________________________________
Company
and that, for and on behalf of said company, he executed, signed and delivered the foregoing instrument
as the act and deed of said company and that he was, at the time of the execution thereof, authorized so to
do.
WITNESS my hand and seal of office this _____________ day of ______________________________.
____________________________________
Notary Public
My Commission Expires: ______________________
Form MRD-5, Page 2
rev. 11/02
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