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COLORADO <br /> Minerals Reclamation Permit Annual Report ♦ Division of Reclamation. <br /> Miring antl safety <br /> Disclaimer <br /> UvdaeAatmmcofyowNOI ,,R,,lmatlovP,=tmd Coloado SEtd,pywmnnrvbxt Au wIPaaaxdAu wIRdpNUUvludldga <br /> map). VwmnatpeyAaAeumgF,, mdrvbmitmAeumg Raportaachyaarwliladamauoo,fi,mabi4tyalaasais gadded TIvAnt <br /> Pee is cut aamwgfae. The Pee and Report are for ISAT YEAR'S muting and reclassified season and MUST be paid died ffyow operation <br /> was Fracture <br /> If you here eq estetlreclamauon,esponsibiltyrelease Per me Division of Reclamation,Muting and Safety I Thesauri but vow Saturday <br /> of released by me annivdaaq date listed below,me Annual Pee MUST be paid If me patina released before me annivdaaq date,used <br /> by Statute,it a not necessary to pay an Awmil Pee or submit an Awmil Report for met year <br /> DirinnodremNs indicate me mlowingw due: <br /> Select Permit Number# <br /> Only Permit Numbers with currently due Annual fees will be listed If the Permit Number Is not listed, Men the Annual fees are not <br /> due, the Permit Number has already been submitted, or the Permit Number Annual fee payment has been processed. <br /> M2014019 <br /> Select Anniversary Bate <br /> 05 16 2016 <br /> IF THE COMPLETE ANNUAL FEE SUBMITTALS ARE NOT RECEIVED ON OR BEFORE YOUR ANNIVERSARY DATE, THE <br /> ENFORCEMENT PROCESS WILL AUTOMATICALLY BE INITIATED. ENFORCEMENT ACTIONS WILL RESULT IN CIVIL <br /> PENALTIES AND POSSIBLE REVOCATION OF YOUR PERMIT <br /> Please check the box indicating you have read and understand the terms of the Annual Report and <br /> Annual Fee* <br /> + I understand and agree to the terms <br /> General Information <br /> Permitted Name <br /> Las Animas County <br /> Operation Name <br /> Mesa DeMaya PI[ <br /> Mai <br /> Permit Number Fee Due Permit Acreage <br /> M2014019 323.00 8.50 <br /> County Anniversary Bate Current Bond Amount <br /> Las Animas 05162016 0.00 <br /> Permittee Contact Information <br /> Permitting Contact Name <br /> Phil Derenkamp <br /> Company <br /> Las Animas County <br /> Address 1 <br /> 2000 N. Linden Ave. <br /> Address 2 <br /> Name— <br /> City State Zip Code <br /> Trinidad CO 810820000 <br /> Phone # Fax # <br /> 7198452568 7198452598 <br /> Permitting Contact Email Address <br /> Is the Permitting Contact information listed above correct? If it is not correct your organization's <br /> Administrator will receive an email notification.# <br /> Yes No <br /> Annual Report Questions <br /> Information contained in this deport is required and w0 be reviewed by Fare Division upon receipt and pnorto Fare Tens <br /> compliance inspection of the site It wWe completing this repots you team Chad vow site is not in compliance witlr the aides and <br /> Fare act it is advisable Chat Me issues be rectified promptly to avoid possible enforcement action <br /> 1. Is the site identification sign posted in accordance with Rule 3.1.12(1).# <br /> Yes No <br /> 2. Is the affected area boundary clearly marked in accordance with Rule el did <br /> Yes No <br /> 3. Is the mine site in final reclamation (all material extraction and stockpile removal is completed?did <br /> If'YES,' please note time limits related to completion of reclamation, Rule s.13 <br /> O Yes • No <br /> 4. Has excavation, processing or hauling activity commenced at the site'did <br /> O Yes No <br /> What was the date of last excavation, processing or hauling activity at the mine?did <br /> 31 <br /> 5. Does the mine operate more than 180 days per year?did <br /> If'NO', please review Rule 1.13 to assure that your mine Is In compliance. <br /> 0 Yes I No <br /> 6. Has this mine been granted approval of TEMPORARY CESSATION Status'did <br /> 0 Yes 0 No <br /> ]. Has this mine been granted approval for INTERMITTENT OPERATION?1 <br /> 0 Yes 0 No <br /> 8. Number of acres currently affected (mining + incomplete and or unreleasetl reclamation).did 0) <br /> 34 <br /> 9. Number of acres that were newly affected during the current report yearsk 0) <br /> 00 <br /> 10. Number of acres that were reclaimed during the current report year.sk 0) <br /> 00 <br /> 11. Estimated new acreage to be affected in the next report year.sk 0) <br /> 00 <br /> 12. Estimated acres to be reclaimed in the next report year.sk 0) <br /> 00 <br /> 13. Total acres in various stages of reclamation since pemtitted Total activities began <br /> Total acres backfilled f O) <br /> 00 <br /> Total acres graded ed O) <br /> 00 <br /> Total acres seeded with approved mixsk O) <br /> 00 <br /> Seed Application MethOtl# <br /> Total acres fertilizetl with apmvetl fertilizer# O) <br /> 00 <br /> Fertilizer Application Method f <br /> Total acres with topsoil replaced did O) <br /> 00 <br /> Topsoil replacement depth (in.)did O) <br /> 00 <br /> Total acres mulched with approved mulch did ( ) <br /> 00 <br /> Mulch application rate (tons/ac)# O) <br /> 00 <br /> Mulch Application MethOtl# <br /> 14. Is weed control being conducted in accordance with an approved Weed Control Plan'did <br /> If'YES', Indicate the weed species, control area, control type, application rate and treatment date on the report map. <br /> • Yes No N/A <br /> 15. 1s adequate topsoil reserved for reclamation, based on your approved permit?did <br /> If'NO', please explain <br /> • Yes No N/A <br /> 16. Is the reserved topsoil vegetated/stabilized in accordance with Rule el did <br /> If'NO', please explain <br /> • Yes No N/A <br /> 17. If mining has exposed groundwater, is the site in compliance with the approved mining plan and <br /> Office of the State Engineer (Well Permit, S.W.S.P., and/or Permanent Augmentation Plan)?1 <br /> Yes No • N/A <br /> 18. Are all hazardous materials stored within approved spill containment structures?# <br /> Yes No • N/A <br /> 19. Is your financial warranty value sufficient to cover the cost to complete reclamation?did <br /> Yes No • N/A <br /> 20. Is your basis for legal right to enter still valitl? f <br /> OO Yes No <br /> 21. Does your permit require you to submit monitoring information annually?did <br /> 0 Yes No • N/A <br /> 22. As required by Colorado Mined Land Reclamation Act and/or Colorado Land Reclamation Act for the <br /> Extraction of Construction Materials (C.R.S.34-32-116 or 34-32.5-116), attach a map to this report that <br /> accurately depicts the permit boundary, current affected area boundary and location of the acreages <br /> specified in items 8-12 and 15.# <br /> Only PDT formatted files can be uploaded <br /> 2016 mesa map put 229 34KB <br /> 23. If you have supplemental information you would like to provide, please upload it here. <br /> Only PDT formatted files can be uploaded. <br /> 24. Rule 5.7 requires submittal of final abandonment reports within 60 days for any drill hotels) with <br /> artesian flows and no later than 12 months for all other completed drill holes. If drill holes are a <br /> component of your exploration/prospecting activities, have they been properly abandoned? <br /> Yes P No an NA <br /> Annual Fee Payment <br /> Payment Confirmation Number# O) <br /> 57331550 <br /> Signature <br /> Submittal Bate <br /> 0421-2016 <br /> I, the undersigned, hereby state that the information provided in this report is true and accurate, <br /> and that site operations are being conducted in accordance with the Division approved mining and <br /> reclamation plans.ok <br /> I Agree <br />