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Permittee Contact: <br />Tom Brubaker <br />Permittee Company: <br />Valco Canon City Concrete Div. <br />Address: <br />12753 S. Parker Rd. Suite # 203 <br />Parker, CO 80134 <br />Phone Number: <br />(303) 248 -3590 <br />Fax Number: <br />(303) 248 -3590 <br />Email Address: <br />CF.PR.email <br />13. Is weed control being conducted in accordance with an approved Weed Control Plan? YES <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 />Signa re of Permittee, Corporate Officer, • wner, or Documented Designee Date <br />Z ^ -20(3 <br />Page 3 of 3 <br />N/A <br />If "YES ", indicate the weed species, control area, control type, application rate and treatment date on t —report map. <br />NO N/A <br />NO N/A <br />16. If mining has exposed groundwater, is the site in compliance with the approved mining plan an ice of the State <br />Engineer (Well Permit, S.W.S.P., and/or Permanent Augmentation Plan)? NO N/A <br />17. Are all hazardous materials stored within approved spill containment structures? NO N/A <br />18. Is your financial warranty value sufficient to cover the cost to complete reclamation? NO N/A <br />19. Is your basis for legal right to enter still valid? NO <br />20. Does your permit require you to submit monitoring information annually? YE 3 NO N/A <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 />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 />