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~~ ~. d2PT <br />PERMIT°I'EE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Farnsworth Construction Co. J~ <br />M-1982-154 <br />Farnsworth Gr Pit 2 <br />November 5, 2007 <br />$$323.00 (Due on or before your anniversary date) <br />Delta <br />I'~ <br />RECEI\/ED <br />NOV 0 2 2007 ~ <br />Division of Reclamation, ~/ <br />Mining and Safety /" <br />According to C.R.S. 34-32.5-116 or C.RS. 34-32-116, each yeaz, 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-accomplished-to-date-and-during the preceding yr, new~isturbances-that are-anticipated-ta occrs - <br />during the upcoming year, reclamation that will be performed during the coming yeaz, the dates for the beginning <br />of active operations, and the date active operarions ceased for the year, if any. <br />Please attach vonr revised written annual report and annual report map to this form. The Annual Report <br />& Fee requirement is not met anti) we have received the following components: fee. report. and associated <br />map. If no new disturbances or reclamation have occurred darinc the previous veer and no new chances to <br />the arevious user's man are necessary. then no new man is reaaired, provided that the Operator shah state <br />this in the Anneal Report. Please note that an adequately labeled map that clearly delineates and includes the <br />above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Patricia Farnsworth <br />Permittee Name: Farnsworth Construction Co. <br />Address: 175 Hwy 133 <br />Phone Number: <br />Fax Number: <br />Paonia, CO 81428 <br />(970) 527-4434 <br />(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 />l~ ~ <br />Signature of Corporate Off7cer, Owner, or Designee <br />/v~3~~p <br />Date <br />