2017-01-19_REPORT - M1992100

• Permit No: M1992100
• IBM Index Class Name: REPORT
• Doc Date: 1/19/2017
• Doc Name: Annual Fee/Report/Map
• From: River Bottom Land Corporation
• To: DRMS
• Annual Report Year: 2017
• Email Name: SJM
• Media Type: D
• Archive: No

Page 5 of 5
Division records indicate the following permittee/landowner contact information(blank fields indicate that we do not have
information on record). If this information is blank or not current,please type or print current contact information:
Permittee Contact: Patricia Farnsworth
Permittee Company: River Bottom Land Corporation
Address: 175 Highway 133
Paonia,CO 81428
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact: Patricia Farnsworth
Company: River Bottom Land Corporation
Address: 175 Highway 133
Paonia, CO 81428
Phone Number: [phone]
Fax Number:
Email Address: [e-mail]
Inspection Contact: Patricia Farnsworth
Company: River Bottom Land Corporation
Address: 175 Highway 133
Paonia, CO 81428
Phone Number: [phone]
Fax Number:
Email Address: [e-mail]
I,the undersigned,hereby state that the information provided in this report is true and accurate, and that site operations are
being conducted in accordance with the Division approved mining and reclamation plans.
C Signature of Permittee Coro to Officer,Owner,or Documented Designee Date
M-AF-01