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Permittee Contact: <br />MARY Kauffman <br />Permittee Company: <br />JAKE KAUFFMAN & SON <br />INC <br />Address: <br />808 SCR 9E <br />Loveland, CO 80537 <br />Phone Number: <br />(970) 667 -1557 <br />1e // <br />1 20 -- <br />,2-9 <br />- e// 5" <br />Fax Number: <br />(970) 667 -9985 <br />Email Address: <br />CF.PR.email <br />/ <br />Signature of P <br />ittee, Co 'ate Officer, Owner, <br />Documented Desig ee <br />13. Is weed control being conducted in accordance with an approved Weed Control Plan? NO N/A <br />If "YES ", indicate the weed species, control area, control type, application rate and treatment date on the report map. <br />CY� NO N/A <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)? ICED NO N/A <br />If "NO" please explain: <br />16. If mining has exposed groundwater, is the site in compliance with the approved mining plan an <br />Engineer (Well Permit, S.W.S.P., and /or Permanent Augmentation Plan)? <br />YES <br />Page 3 of 3 <br />ffice of the State <br />NO N/A <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 />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 />NO N/A) <br />NO N/A <br />Y� NO <br />YES NO N/A <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 />/ 22 <br />Date <br />