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Permittee Contact: <br />Don Loloff <br />Permittee Company: <br />Loloff Construction, Inc. <br />Address: <br />P.O. Box 518 <br />206 Hill St. <br />Kersey, CO 80644 <br />Phone Number: <br />(970) 352 -5595 <br />Fax Number: <br />970 - 3 7-iY- /723 <br />Email Address: <br />CF.PR.email <br />13. Is weed control being conducted in accordance with an approved Weed Control Plan? YES 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? <br />If "NO ", please explain: <br />15. Is the reserved topsoil vegetated/stabilized in accordance with Rule 3.1.9(1)? YES <br />If "NO" please explain: <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 />I, the undersigned, <br />being conducte <br />Signature of Permitte <br />rdance with the ,vision approved mining and reclamation plans. <br />Corporate <br />, Owner, or Documented Designee <br />YES N/A <br />YES <br />NO <br />16. If mining has exposed groundwater, is the site in compliance with the approved mining plan and Office of the State <br />Engineer (Well Permit, S.W.S.P., and/or Permanent Augmentation Plan)? YES NO) N/A <br />Page 3 of 3 <br />N/A <br />NO N/A <br />NO N/A <br />NO <br />N/A <br />21. As required by rule, attach a map to this report that accurately depicts the permit boundary, current affected a a <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 />state that the information provided in this report is true and accurate, and that site operations are <br />/0` - 2 0 1 2 <br />Date <br />