2011-11-16_REPORT - M1979059 (3)

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Permittee Contact: Richard Coulson, CEO Permittee Company: Coulson Excavating Co, Inc Address: 3609 North County Rd 13 Loveland, Co. 80538 Phone Number: 970 - 667 -2178 Fax Number: 970 - 667 -2193 Email Address: diana@coulsonex.com 13. Attach a map to this report that accurately depicts the permit boundary, current affected area boundary and location of the acreages specified in items 7- 12 and 14. Please check the appropriate response below: UPDATED MAP ATTACHED: CONDITIONS UNCHAGED - PREVIOUS MAP ACCURATE: x 14. Is weed control being conducted in accordance with an approved Weed Control Plan? ® NO N/A If "YES ", indicate the weed species, control area, control type, application rate and treatment date on the report map. 15. Is adequate topsoil reserved for reclamation, based on your approved permit? If "NO ", please explain: 16. Is the reserved topsoil vegetated /stabilized in accordance with Rule 3.1.9(1)? If "NO" please explain: 21. Does your permit require you to submit monitoring information annually? If "Yes ", please attach the required monitoring results to this annual report. Please provide current contact information: Signature of Corporate Offider, Owner, or Documented Designee Date Diana Moneypenny, Secretary Nov. 15, 2011 NO N/A NO N/A 17. If mining has exposed groundwater, is the site in compliance withthe_.appr_ovedlnin and Office of_th.e_- State Engineer (Well Permit, S.W.S.P., and /or Permanent Augmentation Plan)? NO N/A 18. Are all hazardous materials stored within approved spill containment structures? NO N/A 19. Is your financial warranty value sufficient to cover the cost to complete reclamation? NO N/A 20. Is your basis for legal right to enter is still valid? NO YES N/A I, the undersigned, hereby state that the information provided in this report is true and accurate, and that site operations are being conducted in accordance with the Division approved mining and reclamation plans.