Surface_Mining_and_Reclamation_Act_Certification_Form.pdf

This document is a Surface Mining and Reclamation Act Certification Form issued by the California Department of Conservation in October 2004. The form is designed for vendors and suppliers to certify that the materials they propose to supply meet specific regulatory requirements under Public Resources Code Section 2710 et seq. and Public Contract Code Section 10295.5. The form requires vendors to provide details about the source of their materials, including the mine name, mine ID number, operator, and county of origin.

The certification form serves as a compliance document ensuring that suppliers are utilizing materials from mines that are listed and approved by the California Department of Conservation. By completing and signing this form, vendors attest that their materials are sourced from mines that adhere to the Surface Mining and Reclamation Act (AB 3098), which likely involves environmental and operational standards for surface mining activities. The form includes spaces for the vendor's contact information, an authorized signature, date, and phone number, allowing for proper documentation and verification of the material sourcing.