2005-11-04_REPORT - M1982154

• Permit No: M1982154
• IBM Index Class Name: Report
• Doc Date: 11/4/2005
• Doc Name: Annual Fee/Report/Map
• From: Farnsworth Construction Co.
• To: DMG
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
AjN~NiiAi, FF.F, and RF.PnRT RF.ni1F,ST
" Fa sworth Construction Co.
t/M-1982-154
Farnsworth Gr Pit 2
November 5, 2005
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~O~J 0/4 2005
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$281.00 (Due on or before your anniversary date)
Delta
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
shall submit the-anrsual-fee,-'a report-and-map-showing the-extent-of-current-disturbances-to-affected-land,
reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur
during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning
of active operations, and the date active operations ceased for the year, if any.
Please attach ynnr revised written annnal report and annnal rennrt man to this form. Please note that an
adequately labeled map that clearly delineates and includes the above elements may since for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Patricia Famsworth
Permittee Name: Famsworth Constmction Co.
Address: 175 Hwy. 133
Phone Number:
Fax Number:
Paonia, CO 81428
[phone]
[phone]
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instmctions are enclosed.
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~igiature of Corpor e fficer, Owner, or Designee
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Date