2012-02-01_REPORT - M1977219

• Permit No: M1977219
• IBM Index Class Name: REPORT
• Doc Date: 2/1/2012
• Doc Name: Annual Fee/Report Notice
• From: DRMS
• To: Summit Brick
• Permit Index Doc Type: Annual Fee/Report
• Media Type: D
• Archive: No

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:
14. Is weed control being conducted in accordance with an approved Weed Control Plan? YES 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:
YES NO N/A
YES NO N/A
17. If mining has exposed groundwater, is the site in compliance with the approved mining plan and Office of the
State Engineer (Well Permit, S.W.S.P., and /or Permanent Augmentation Plan)? YES NO N/A
18. Are all hazardous materials stored within approved spill containment structures? YES NO N/A
19. Is your financial warranty value sufficient to cover the cost to complete reclamation? YES NO N/A
20. Is your basis for legal right to enter is still valid? YES NO
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:
YES NO N/A
Permittee Contact:
Permittee Company:
Address:
Phone Number:
Fax Number:
Email Address:
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.
Signature of Corporate Officer, Owner, or Documented Designee Date