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c~ ~~ <br />n <br />ANNiiAi. FF.F. and RRP(1RT RFQjjFST <br />- . - =a <br />PERMITTEE NAME: A. J. Botti Constructiou & Gravel <br /> ~ ~ 6 Z~0~ <br />PERMIT NO.: M-1997-027 <br />OPERATION NAME: Moonscape Pit O'Wiiroa of Minerals & Geology <br />ANNIVERSARY DATE: January 30, 2004 <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 operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />---- -reclamation-aecomplislied-to-dateand-during-the-preceding_year,-new-disturbances_thatare_antirin~to occuc_ _ _ <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 annnal rennrt and anmral re nrn t man n this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffce for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: . Botti <br /> <br />Permittee Name: A. J. Botti Construction & Gravel <br />Address: ~~4°~-~gO--B~ <br />~,L9 l~ .~ V ;~~r~ r n I.r J ~~ <br />Delta, CO 81416-9107 <br />Phone Number: (970) 874-8141 <br />FazNum e-~[- - - - - -_ ----- -- ---' -- -- <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 />Signature of orporate facer, Owner, or Designee _ <br />/- ~-c~ y <br />Date <br />M:\PERMITVNASTERDOCIJMENTS~M-AF-01 <br />~///SS <br />~.l <br />