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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Farnsworth Construction Co. <br />M-1982-154 <br />Farnsworth Gr Pit 2 <br />November 5, 2003 <br />RECEII/ED <br />®cr z o zoos <br />Division of Minerals & Geology <br />$281.00 (Due on or before your anniversary date) <br />Delta <br />According to C.R.S, 34-32.5-1 l6 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an operator <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annual rennrt and annual rennrt mad to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Phase verify and make any necessary <br />changes: <br />Permittee Contact: Patricia Farnsworth <br />Permittee Name: Farnsworth Construction Co. <br />Address: .I~494-Hwy-33^ ,$o-^~-.a, I°~`'~'~~m, ~ 701 ~~uJ~J f~J~ <br />h 2u1 AtEa~n"' es5 ,, ~j <br />Paonia, CO 81428 ~A.B-~.GO. ,~ t~ l ~ do <br />Phone Number: (970) 527-4434 <br />- Faz 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 enclosed. <br />v/7 /GZ3 <br />Date <br />M:\PERMIT\MASTERDOCUM ENTSUI-AF-01 <br />