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Permittee Contact: <br />2 ) <br />IgkE <br />ntilizer <br />►plication <br />ethod: <br />Permittee Company: <br />Mulch <br />application <br />method: <br />,0, fd I <br />Address: <br />4. <br />i <br />Phone Number. <br />Fax Number: <br />Email Address: 1. <br />,icy >"/< <br />Seed <br />application <br />method: <br />AVjp �_ <br />IgkE <br />ntilizer <br />►plication <br />ethod: <br />444, <br />Mulch <br />application <br />method: <br />,0, fd I <br />13. Attach a map to this report that accura <br />the acreages specified in items 7 -12 <br />UPDATED MAP ATTACHED: <br />14. Is weed control being conducted in • . • :11 with an approved Weed Control YES -1 Na Ate` <br />If "YES ", indicate the weed species, c ntrol area, control type, application rate and treatment date on the r ' • rt map. <br />15. Is adequate topsoil reserved for rec on, based on your approved permit? NO /A <br />If "NO", please explain: _ <br />16. Is the reserved topsoil vegetated/stab ed in accordance with Rule 3.1.9(1)? <br />If "NO' please explain: <br />17. If mining has exposed groundwater, is i site in compliance with the approved mining plan and Office of the <br />Engineer (Well Permit, S.W.S.P., and/ <br />18. Are all hazardous materials stored wi <br />19. Is your financial warranty value suffi <br />20. Is your basis for legal right to enter s <br />21. Does your permit require you to submi monitoring information annually? <br />If "Yes ", please attach the required m <br />Division records indicate the following <br />print current contact information: <br />I, the undersigned, hereby state that the ' . rmation provided in this report is true and accurate, and that site opera ions <br />are being conducted in accordance with th - Division approved mining and reclamation plans. <br />Signature of Corporate Officer, Owner, <br />6 aced <br />• a1 It <br />BSBb- *LB-SBL <br />ely depicts the permit boundary,ourrentaffe.cted <br />1.4-- Pleasefieck the appropriate response below: <br />CONDITIONS UNCHANGED - PREVIOUS MAP ACCURATE: <br />Permanent Augmentation Plan)? YES-. NO <br />approved spill containment structures? <br />to cover the cost to complete reclamation? <br />valid? <br />toning results to this annual report. <br />contact information. If this information is not current, please - or <br />XH3 13C213S141 dH <br />.sr c.. ■v:.u. • <br />YES NO <br />'fir. <br />Date <br />NO /A <br />NO /A <br />NO <br />YES /A <br />BT =ST ETOZ OZ .idd <br />