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~' <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />~A. J. Botti Construction & Gravel <br />,/M-1997-027 <br />Moonscape Pit <br />January 30, 2007 <br />~~ ~ ~~' <br />~~aN ~ ~ zoo' <br />Division Rf Raolamatl®R, <br />/ AtIRIRQ 8R~ i~ttf~ly <br />$$281.00 (Due on or before your anniversary date) <br />Delta <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />during the upcoming yeaz, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Pease attach your revised written annual report and annual report map to this form. The Anpual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred during the previous year and no new chances to <br />the previous year's map are necessary, then no new map is reouired, provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Andrew J. Botti <br />Permittee Name: A. J. Botti Construction & Gravel <br />Address: 4608 Sundown Rd. <br />Phone Number: <br />Fax Number: <br />Delta, CO 81416-9107 <br />(970)874-8141 <br />(970)874-8141 <br />If you have additional comments and/or information that should be provided to the Division, please provide <br />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />Sign ~ of Corporate Officer, Owner, or Designee <br />Date <br />