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Permittee Contact: <br />R I)4r Cnn &l/ <br />Permittee Company: <br />Co nn -e /f R es cQ T <br />Address: <br />77 65 17 mek4DW <br />5 v L t-e l 0O <br />f y7 Ca /11)15, Co g©5Z? <br />?kW/ <br />Phone Number: <br />9 70 - z 23- 3 l 5/ <br />Fax Number: <br />97t9 -- Z 3- 3 i t / <br />Email Address: <br />bCenn.en EConn .e/1 Ye6ovvice <br />Corn <br />J <br />13. Attach a map to this report that accurately depicts the permit boundary, current affected area boundary and <br />location of the acreages specified in items 7- 12 and 14. Please check the appropriate response below: <br />UPDATED MAP ATTACHED: X <br />CONDITIONS UNCHAGED - PREVIOUS MAP ACCURATE: <br />16. Is the reserved topsoil vegetated /stabilized in accordance with Rule 3.1.9(1)? <br />If "NO" please explain: <br />19. Is your financial warranty value sufficient to cover the cost to complete reclamation? <br />20. Is your basis for legal right to enter is still valid? <br />Please provide current contact information: <br />Signature of Corporate Officer, Owner, or Documented Designee <br />14. Is weed control being conducted in accordance with an approved Weed Control Plan? ES NO N/A <br />If "YES ", indicate the weed species, control area, control type, application rate and treatment date on the <br />report map. c a 7 d/4 ►N. -1- /5 -tic 2. `/J, 1/.5 a ,oe 1-64/ 0144 ® 4 49 014 .9 4:11 "'" I n <br />5onvrkev' MDnMts 'Ave vv t reo Lot 4 <br />15. Is adequate topsoil reserved for reclamation, based on your approved permit? (YE) NO N/A <br />If "NO ", please explain: <br />17. If mining hasexp, $agrqundwater is the sit ,, ph, tce with the ap oved mining pl. ' and Office of the <br />: Stat ineer_(Wel1 Permit, S- W.S.P. and or- Permanent Augmentation Plan)? ` o -N0 N/A <br />18. Are all hazardous materials stored within approved spill containment structures? <br />NO N/A <br />ES NO N/A <br />NO N/A <br />NO <br />21. Does your permit require you to submit monitoring information annually? YES N/A <br />If "Yes ", please attach the required monitoring results to this annual report. <br />I, the undersigned, hereby state that the information provided in this report is true and accurate, and that site <br />operations are being con •ct9d in accordance with the Division approved mining and reclamation plans. <br />Date <br />