Form 9-4025-A Expanded Perlite

RESTON, VIRGINIA 20192

1. Establishment covered by this report.
1.1 Name and location of plant.
Name

Nearest city or town

County

State

Section

Township

If operation plant is a subsidiary, please name controlling company

1.2 Status during year. (Check and complete one or more)

If ownership changed during year, give date of change
and name and address of other party in transfer

Range

2. Production and disposition of expanded perlite during the year.
REPORT QUANTITY IN SHORT TONS OR CUBIC FEET.
Include sales of expanded perlite and also perlite used by you in the manufacture of other products, such as premixed plaster. Include perlite expanded by you from crude
material purchased from others, but EXCLUDE purchased expanded perlite. For "Value," COLUMN 5, see instruction.

3. Crude perlite purchased from other producers during the year.
If you purchased crude perlite during the year, please give names and addresses of those from whom you purchased and quantity purchased. This information is needed to
avoid duplication of figures.

Remarks: