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r <br /> <br />PERMI"ITEE 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, 2002 <br />RECEIVED <br />JAN i 7 '002 <br />Division oI Minerals and Geology <br />$281.00 (Due on or before your anniversary date) <br />Delta <br /> <br />According [o C.R.S. 34-32.5-116 or C.R.S. 34-32-I 16, 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 vour revised written annual report and annual report map to this form. Please note tlrot art <br />adequately laGe[erf map that clearly delir:eates and includes the above elements may since jot a written report. <br />Division records indicate the following permi[tee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Andy Botti <br />Permittee Name: A.J. Bo[ti Construction & Gravel <br />Address: 454 1250 Dr. <br />Delta, CO 81416-9107 <br />Phone Number: (970) 874-8141 /~ <br />Fax Number: %~r~ 7~/- ~~~~ <br />If you have additional comments and/or information [hat should be provided to the Division, please provide i[ <br />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />tgnatur of Corporate Officer or Owner <br />/-/U- OoZ. <br />Date <br />M ~PERMrM1ASTERD000M11ENr5N1-AF-01 <br />