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Permittee Contact: <br />X � <br />Permittee Company: <br />Address: <br />t 0 3 3� . <br />I? o . 6 cry, 9 <br />`` CeD lor-a4 , a &2 1 <br />TTL' <br />Phone Number: <br />I <br />7 743. 27,3 <br />Fax Number: <br />-- ivi.7- 43. /J <br />Email Address: <br />1 Cia. . u '� 1( c o 1 ( - ITO r - 7%. cn <br />.: . <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: CONDITIONS UNCHAGED - PREVIOUS MAP ACCURATE: <br />14. Is weed control being conducted in accordance with an approved Weed Control Plan? NO N/A <br />If "YES ", indicate the weed species, control area, control type, application rate and treatment date on the <br />report map. <br />15. Is adequate topsoil reserved for reclamation, based on your approved permit? (' ES NO N/A <br />If "NO ", please explain: <br />16. Is the reserved topsoil vegetated /stabilized in accordance with Rule 3.1.9(1)? <br />If "NO" please explain: <br />17. If mining has exposed groundwater, is the site in compliance with the approved mining plan and Office o <br />State Engineer (Well Permit, S.W.S.P., and /or Permanent Augmentation Plan)? YES NO <br />18. Are all hazardous materials stored within approved spill containment structures? YES NO <br />19. Is your financial warranty value sufficient to cover the cost to complete reclamation? YES NO <br />20. Is your basis for legal right to enter is still valid? NO <br />21. Does your permit require you to submit monitoring information annually? <br />If "Yes ", please attach the required monitoring results to this annual report. <br />Please provide current contact information: <br />I, the undersigned, hereby state that the information provided in this report is true and accurate, and that site <br />operations are being conducted in accordance with the Division approved mining and reclamation plans. <br />".".V. nAV\ Me -- - <br />Signature of Corporate Officer, Owner, or Documented Designee Date <br />I 2) 2 <br />YES <br />NO N/A <br />N/A <br />