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w <br /> C III fill III <br /> 999 <br /> ANNUAL FEE and REPORT REOUEST <br /> PERMITTEENAME: Farnsworth Construction Co. RECEIVED <br /> PERMIT NO.: M-1982-154 OCT 2 3 2000 <br /> OPERATION NAME: Farnsworth Gr Pit 2 <br /> ANNIVERSARY DATE: November 5, 2000 Division of Minerals and Geology <br /> ANNUAL FEE DUE: $281.00(Due on or before your anniversary date) <br /> COUNTY: 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 <br /> operator shall submit the annual fee, a.report and map showing the extent of current disturbances to affected <br /> land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br /> occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br /> beginning 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. Please note that an <br /> adequately labeled map that clearly delineates and includes the above elements may since for a written <br /> report. <br /> Division records indicate the following permittee contact information. Please verify and make any necessary <br /> changes: <br /> Permittee Contact: Patricia Farnsworth <br /> Permitlee Name: Farnsworth Construction Co. <br /> Address: 1494 Hwy. 33 <br /> Paonia,CO 81428 <br /> Phone Number: (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 instructions are <br /> enclosed. <br /> Signature of orate Officer or Owner <br /> /0 —CD — l/U <br /> Date <br /> M WERMITIMASTERDOCUMENTSVA-AF-01 <br />