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Permittee Contact: <br />Patrick Fischer <br />Permittee Company: <br />CEMEX, Inc. <br />Address: <br />P.O. Box 529 <br />Lyons, CO 80540 <br />Phone Number: <br />(303) 823 -2100 <br />Fax Number: <br />Email Address: <br />CF.PR.email <br />13. Is weed control being conducted in accordance with an approved Weed Control Plan? YES NO <br />If "YES ", indicate the weed species, control area, control type, application rate and treatment date on the repo ap. <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 3.1.9(1)? <br />If "NO" please explain: <br />16. If mining has exposed groundwater, is the site in compliance with the approved mining plan and Office of the St <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 cover the cost to complete reclamation? <br />19. Is your basis for legal right to enter still valid? <br />20. Does your permit require you to submit monitoring information annually? <br />If "Yes ", please attach the required monitoring results to this Annual Report. <br />Sign <br />wner, or Documented Designee <br />YES NO <br />YES <br />Page 3 of 3 <br />NO N/A <br />NO N/A <br />N/A <br />NO N/A <br />NO <br />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: <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 i • mation provided in this report is true and accurate, and that site operations are <br />being conduc accordance with the vision ap. aved mining and reclamation plans. <br />1?-3-2012- <br />Date <br />