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Page 1 of 3
OMB Control No. 1028-0065
Approval expires: 7/31/2010
USGS Form 9-4142-Q
Ind. (rev. 3/15/2007)
AG1
UNITED STATES
DEPARTMENT OF THE INTERIOR
U.S. GEOLOGICAL SURVEY
986 NATIONAL CENTER
RESTON, VIRGINIA 20192
_______________
CRUSHED AND BROKEN STONE & CONSTRUCTION SAND AND GRAVEL
_______________
Please complete all applicable portions of this form
z
z
z
z
z
INDIVIDUAL COMPANY DATA PROPRIETARY
Name of company.
Crushed and broken stone.
Construction sand and gravel.
Remarks.
Person to be contacted regarding this report.
Company.
Controlling company name
Controlling company ID
Operating (subsidiary) company name
Operating (subsidiary) company ID
Address
City or town
County
State / Territory / Province
Not specified
ZIP Code / Postal Code
USA
Country
Section 1. Crushed and broken stone.
What was the total amount of crushed and broken stone sold and/or used for the previous quarter in each State in
which you operated?
State
CRUSHED AND BROKEN STONE
QUARTER
No. of
1ST
2ND
3RD
operations
Jan. - Mar.
Apr. - Jun.
Jul. - Sep.
4TH
Oct. - Dec.
Please specify
https://miforms.er.usgs.gov/ViewForms/AG1Form.asp?canvassCode=AG1
8/4/2009
AG1-Q - CRUSHED AND BROKEN STONE & CONSTRUCTION SAND AND GRA...
Page 2 of 3
Please specify
Please specify
Please specify
Please specify
Please specify
Please specify
Please specify
Please specify
Please specify
Please specify
Please specify
Please specify
Please specify
Please specify
More States
Section 2: Construction sand and gravel.
What was the total amount of sand and gravel sold and/or used for the previous quarter in each State in which you
operated?
State
CONSTRUCTION SAND AND GRAVEL
QUARTER
No. of
1ST
2ND
3RD
operations
Jan. - Mar.
Apr. - Jun.
Jul. - Sep.
4TH
Oct. - Dec.
Please specify
Please specify
Please specify
Please specify
Please specify
Please specify
Please specify
Please specify
Please specify
Please specify
Please specify
Please specify
Please specify
Please specify
Please specify
https://miforms.er.usgs.gov/ViewForms/AG1Form.asp?canvassCode=AG1
8/4/2009
AG1-Q - CRUSHED AND BROKEN STONE & CONSTRUCTION SAND AND GRA...
Page 3 of 3
More States
Remarks:
Person to be contacted regarding this report.
First name:
Last name:
Title:
E-mail:
Address:
City:
State / Territory / Province: Not specified
ZIP Code / Postal Code:
Country:
USA
Phone:
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https://miforms.er.usgs.gov/ViewForms/AG1Form.asp?canvassCode=AG1
8/4/2009
File Type | application/pdf |
File Title | https://miforms.er.usgs.gov/ViewForms/AG1Form.asp?canvassCode=A |
Author | sstoller |
File Modified | 2009-08-04 |
File Created | 2009-08-04 |