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5 55 <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 />///Farnsworth Construction Co. <br />t~ M-1982-154 <br />Farnsworth Gr Pit 2 <br />November 5, 2006 <br />//-06 orb <br />~~~NOV 0 2 2006 <br />" uivision of Reclamation, <br />Mining and Safefy <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 />reclamation accomplished to date and during the preceding year, new disturbances that_are anticipated to occur _ <br />during the upcoming year, 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 />Please attach your revised written annual report and annual report map to this form. The Annual 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 durinc the previous year and no new chances to <br />the previous year's map are necessary, then no new map is required, provided that the Operator shall state <br />this in the Annual Report. Please note dhat 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: Patricia Famsworth <br />Permittee Name: Famsworth Construction Co. <br />Address: <br />Phone Number: <br />175 Hwy. 133 <br />Paonia, CO 81428 <br />(970)527-4434 <br />Fax Number: (970) 527-5522 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instmctions are enclosed. <br />~ f/f <br />~Sigx rate Officer, Owner, or Designee <br />/~ ~-.30 <br />Date <br />