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<br />['TEE NAME: <br />C NO.: <br />TION NAME: <br />ERSARY DATE: <br />1L FEE DUE: <br />ANNiTAi. FF.F, and RFPt7RT RF.(IiTF.ST <br />~/ Farnsworth Construction & Gravel Co. <br />~-2004-025 <br />North Fork Pit <br />April 22, 2006 <br />RECR®~~® <br />~ .. <br />>%„ ~R? ~ ~ <br />ut Minere/a arttl 6entoBY <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 />reiimtion-accomp}ished-to-date-and-duringthe-preceding'y`ear; new disturbances that are ant~ctpated 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 />ich ynnr revised written annual red nrf and anm~al re nn rt maw to Chic form. Please note that an <br />labeled map that clearly delineates and includes the above elements may suffice for a written report. <br />records indicate the following permittee contact information. Please verify and make any necessary <br />Permittee Contact: Patricia M. Farnsworth <br />Permitt le Name: Farnsworth Construction & Gravel Co. <br />Addres I: 175 Hwy 133 <br />Paonia, CO 81428 <br />Phone Number: _ (970) 527-4434 <br />Fax Nu i ber: '~ ~ _ <br />~~a-sa7-s~~a.., . ~ <br />If you I ve additional comments and/or information that should be provided to the Division, please provide it <br />below o ~ attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />Signaturi of Corporate Officer, ner, or Designee ~~~q4 ~~ <br />/90/v <br />Date <br />~~ ~c. 7 Z ~ ~ ~l/i 9~0 /~ <br />