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Permittee Contact: <br />Don Van Wormer <br />Permittee Company: <br />City of Monte Vista <br />Address: <br />4 Chico Camino <br />Monte Vista, CO 81144 <br />Phone Number: <br />(719) 852 -2692 <br />Fax Number: <br />(719) 852 -6172 <br />Email Address: <br />CF.PR.email <br />13. Is weed control being conducted in accordance with an approved Weed Control Plan? YES NO ( /N A ' <br />If "YES ", indicate the weed species, control area, control type, application rate and treatment date on the report map. <br />14. Is adequate topsoil reserved for reclamation, based on your approved permit? c YES NO N/A <br />If "NO ", please explain: ve <br />15. Is the reserved topsoil vegetated/stabilized in accordance with Rule 3.1.9(1)? <br />If "NO" please explain: <br />YEAS NO N/A <br />16. If mining has exposed groundwater, is the site in compliance with the approved mining plan and Office of the St t <br />Engineer (Well Permit, S.W.S.P., and /or Permanent Augmentation Plan)? YES NO ( N/A <br />17. Are all hazardous materials, stored within approved spill containment structures? YES NO ( <br />N. /A <br />A./o frtA�-,0Le ∎als 5 <br />18. Is your financial warranty value sufficient to cover the cost to complete reclamation? YES' NO N/A <br />19. Is your basis for legal right to enter still valid? <br />20. Does your permit require you to submit monitoring information annually? /01 <br />If "Yes ", please attach the required monitoring results to this Annual Report. . <br />YES) NO <br />YES NO N/A <br />21. 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: Y46 <br />Division records indicate the following permittee contact information. If this information is not current, please type or <br />print current contact information: <br />Cr }0644 l� ® )Y4,1,44 C"tL. Gb. us <br />I, the undersigned, hereby state that the information provided 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 />1 <br />Signature of Permittee, Corporate Officer, Owner, or Documented Designee Date <br />Page 3 of 3 <br />