2015-12-08_REPORT - M2006039

• Permit No: M2006039
• IBM Index Class Name: Report
• Doc Date: 12/8/2015
• From: North Clear Creek Construction
• To: DRMS
• Annual Report Year: 2014
• Permit Index Doc Type: Annual Fee/Report
• Email Name: ACY
• Media Type: D
• Archive: No

Page 4 of 5
Seed Fertilizer M ulcl
application �r �� / application applic tion
method: f method: 1� metho : /lc'
13. Is Need control being conducted in accordance with an approved Weed Control Plan? aE ) NO N/A
If"YES", indicate the Need species,control area,control type,application rate and treatment date on the report map.
14. Is adequate topsoil reserved for reclamation,based on your approved permit? YE NO N/A
If"NO",please explain:
15. Is the reserved topsoil vegetated/stabilized in accordance Nvith Rule 3.1.9(1)? YES NO N/A
If"NO"please explain:
16. If mining has exposed groundwater, is the site in compliance with the approved mining plan and Office of the Sojf2o
Engineer(Well Permit,S.W.S.P.,and/or Permanent Augmentation Plan)? YES NO /A
17. Are all hazardous materials stored within approved spill containment structures? YES NO NIA
18. Is your financial warranty value sufficient to cover the cost to complete reclamation? l'ES NO N/A
19. Is your basis for legal right to enter still valid? YE NO
20. Does your permit require you to submit monitoring information annually? YES NO) N/A
If"Yes", please attach the required monitoring results to this Annual Report.
21. As required by Colorado Mined Land Reclamation Act and/or Colorado Land Reclamation Act for the Extraction of
Construction Materials(C.R.S. 34-32-116 or 34-32.5-116),attach a map to this report that accurately depicts the
pert-nit boundary,current affected area boundary and location of the acreages spe ilied in items 7- 12 and 14.
UPDATED MAP ATTACHED:
Division records indicate the following permittee contact information. If this information is not current,please type or
print current contact information:
Permittee Contact: .Julie.Justus
Permittee Company: Chevron Shale Oil Company,a
division of Chevron USA, Inc.
Address: 760 Horizon Drive Suite 412
Grand Junction,CO 81506
Phone Number: [phone]
Fax Number: [phone]
Email Address: CF.PR.email
1, the undersigned,hereby state that the information provided in this report is true anc accurate,and that site operations are
being conducted in accordance with the Division approved mining and reclamation p ans.
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