2015-05-12_REPORT - M2010084

• Permit No: M2010084
• IBM Index Class Name: REPORT
• Doc Date: 5/12/2015
• Doc Name: Annual Fee, Report, & Map
• From: Lost Cause, LLC
• To: DMS
• Email Name: THM
• Media Type: D
• Archive: No

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13. Is weed control being conducted in accordance with an approved Weed Control Plan? YES NO N/A
If "YES", indicate the weed species, control area, control type, application rate and treatment date on the repo p.
14. Is adequate topsoil reserved for reclarnatio,r,, based on your approved permit`' A'ES NO N
Ii --NO`� please exp!ain: .:
15. Is the reserved topsoil vegetated/stabilized in accordance with Rule 3.1.9(1)? YES NO N/A
If "NO" please explain:
i 6. If raining I -Las exposed grottlidw ter, is t11 e site in compliance with the ala rovoci ininin plan and Office- t]1 ti �jae
:.
k tigir_eer (Well l'ennit, 'S.W.S.P., andior Perm hent Nugme tatio Plan)?
21.
YRS
O
` N/A,
Lost Cause, LLC
C address:---
17. Are all hazardous materials stored within approved spill containment structures?
YES
NO
N/A
Rifle, CO 81650
18. Is your financial warranty value sufficient to cover the cost to complete reclamation?
YES
NO
N/A
19. is you: basis for legal right to eater still V,- hid?
k YES
N70
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20. Does your permit require you to submit monitoring information annually?
YES
NO
e/A
eport.
If "Yes", please attach the required monitoring results to this Annual Report-
21. 'As required by "'olotado Mined I -and Reel niation Act and/or Colorado Land Reclamation Act for "lie Extraction, of
Construction Materials (C.R.S. 34-32-116 or 34-32.5-11161; I; ltts ctl 3 nl<:p to this report that accurately sit-pic is the
permit boundary, current affected area boundary and location of the acreages specified in items 7-12 and 14.
UPDATED MAP ATTACHED: ,�/ /J�
Division records indicate the following permittee contact information. If this information is not current, please type or
print current contact infornIVITion:
Permittee Contact:
Tim Mantle
Permittee Company:
Lost Cause, LLC
C address:---
27002) CR
Rifle, CO 81650
Phone Number: [phone]
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I°atvutnl}er _ ; 1970) Q3' 78-40=�
Email Address: CF.PR.email
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I, the vuirlersipjied, hereby state that the information provided in this report is true and acus -Tete, and that site operations are
Bing conductcd in accordance witli the Division approved mining and' reclamation plans.
4
Signature of )permittee, Corporate Officer, Owner, or Documented Desiree
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