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Permittee Contact: <br />Randy Renquist <br />Permittee Company: <br />Sedgwick County <br />Address: <br />223 S Cedar <br />Julesburg. CO 80737 <br />Phone Number: <br />(970) 474 -3576 <br />Fax Number. <br />(970) 474 -3558 <br />Email Address: <br />CF.PR.email <br />Page 3 of 3 <br />13. Is weed control being conducted in accordance with .n approved Wed Control Plan' YES N N/A <br />If "YES ", indicate the weed species, control area. control type. application rate and treatment date on e "report map. <br />14. Is adequate topsoil reserved for reclamation. based on your approved permit'' <br />If "NO please explain: <br />15. Is the reserved topsoil vegetated /stabilized in accordance with Rule 3 19(1 )' <br />If "NO" please explain: <br />16. If mining has exposed groundwater, is the site in compliance lA i th the approved mining plan and Office of the State <br />Engineer (Well Permit. S.W.S.P., and /or Permanent Augmentation Plan)? <br />17. Are all hazardous materials stored within approved spill containment structures <br />18. Is your financial warranty value sufficient to co\er th° cost to complete reclamation'' <br />19. Is your basis for legal right to enter still \alid? <br />21. <br />YES NO dV /A <br />NO N/A <br />NO N/A <br />2 i 'O <br />NO N/A <br />NO N/A <br />YES N_O___)N /A <br />20. Does your permit require you to submit monitoring information annually'? <br />If "Yes ", please attach the required monitoring result, to this Annual Report. <br />As required by rule, attach a map to this report that accurately depicts the permit boundary. current affected area <br />boundary and location of the acreages specified in items 7- 12 and 14. UPDATED MAP ATTACHED. <br />Division records indicate the following permittee contact information. If this information is not current, please type or <br />print current contact information: <br />I, the undersigned, hereby state that the information pro\iJed in this report is true and accurate. and that site operations are <br />being conducted in accordance with the Division approved mining and reclamation plans <br />�s- :D?(2 <br />Signature of Permittee, C porate Officer, Owner, or Documented Designee Date <br />i� <br />