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Permittee Contact: <br />_ <br />\ ��. --\ L. G e -~ <br />Permittee Company: <br />LI) ` Tic - i <br />Address: <br />( p'4-6V4.( ie <br />c.. A(evte,co sets <br />Phone Number: <br />Z+t ( 2" <br />Fax Number: <br />20 8. 2 3 � IZ <br />Email Address: <br />f L U � /IeC14 _714' VI :,,q , Co M <br />13. Attach a map to this report that accurately depicts the permit boundary, current affected area boundary and <br />locati911 of the acreages specified in items 7- 12 angl 14. Please check the appropriate response below: <br />+0 axis r Si 2ri&t <br />UPDATED MAP ATTACHED: CONDITIONS UNCHAGED - PREVIOUS MAP ACCURATE: <br />15. Is adequate topsoil reserved for reclamation, based on your approved permit? <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 />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 />cJ <br />Signature of Corporate 0 fficer, Owner, or Doc ented Designee <br />2 12 <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 />NO N/A <br />YES NO ■/A <br />17. If mining has exposed groundwater, is the site in compliance with the approved mining plan and Office of t <br />State Engineer (Well Permit, S.W.S.P., and /or Permanent Augmentation Plan)? YES NO �N/ <br />18. Are all hazardous materials stored within approved spill containment structures? YES NO N/A <br />19. Is your financial warranty value sufficient to cover the cost to complete reclamation? YES NO N/A <br />20. Is your basis for legal right to enter is still valid? YES NO <br />YES 0 N/A <br />I, the undersigned, hereby s 'a : that the information provided in this report is true and accurate, and that site <br />operations a con in accordance with the Division approved mining and reclamation plans. <br />