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Permittee Contact: <br />julto IA t kuGCS <br />Permittee Company: <br />Address: <br />t 90 N 4 t( 1 lazi- <br />T,' CO3 s CO ()5-1 <br />Phone Number: <br />11 - 7 2.1 - to g 1 <br />Fax Number: <br />Gt-i6 96 3loo <br />Email Address: <br />) 0,,_, , -in,tt f jj a5 0 , <br />rilAit <br />12.4uetu- <br />, C_Prn <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: V / <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. <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 />17. If mining has exposed groundwater, is the site in compliance with the approved mining p , and Office of <br />State Engineer (Well Permit, S.W.S.P., and /or Permanent Augmentation Plan)? p NO <br />18. Are all hazardous materials stored within approved spill containment structures? <br />19. Is your financial warranty value sufficient to cover the cost to complete reclamation? NO N/A <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? NO N/A <br />If "Yes ", please attach the required monitoring results to this annual report. <br />Please provide current contact information: <br />Signatur <br />NO N/A <br />NO N/A <br />NO N/A <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 />L iTV/d r adit/ Corporate Officer, Owner, or Documen Date <br />