REP50755

• Permit No: M1982154
• IBM Index Class Name: Report
• Doc Date: 11/4/2002
• Doc Name: 2002 Annual Report
• From: Farnsworth Construction Co.
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
ANNUAL FEE and REPORT REQUEST
Farnsworth Construction Co.
M-1982-154
Farnsworth Gr Pit 2
November 5, 2002
RECEIVED
NOV 0 4 Y00P
Division otMinerals and llevlog~
$282.00 (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 annual fee, a report and map showing the extent of current disturbances [o affected land,
___reclama[ion-aecompkshed-to-date-and during the-preceding eat;-n~wzYiStfirbances at are anuclpated 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 vour revised written annual report and annual report map to this form. Please note that an
adequately labeled map that clearly delineates aid includes the above elements may suffice for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Patricia Farnsworth
Permittee Name: Farnsworth Construction Co.
Address
Phone Number;
Fax Number:
1494 Hwy. 33
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 instructions are enclosed.
or Designee
M SPERM ITVN ASTERDOCU MENTSV.1-AF-01
/D -30 - d Z
Date