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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />'k ? "eT- <br />ANNUAL FEE and REPORT REOUEST <br />(Al <br />A.J. Botti Construction & Gravel <br />JM-1997-027 <br />Moonscape Pit <br />January 30, 2009 <br />RECFRIFD <br />"AN 2 S 2009 <br />P Division of Reclamation, <br />Mining and Safety <br />$323.00 (Due on or before your anniversary date) <br />Delta <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />-- reclamation-accomplished to-date-and-daring-the-precedingyear,--new_disturbances_that_are:anticipated-to_occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annual report and annual report map to this form The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred during the previous year and no new changes to <br />the previous year's map are necessary, then no new map is required, provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Andrew J. Botti <br />Permittee Name: A.J. Botti Construction & Gravel <br />Address: 4608 Sundown Rd <br />Delta, CO 81416-9107 <br />Phone Number: -(944)-8 -$ <br />Fax Number: 497.0)-894=8t4-17- <br />ZQZ <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 />_'/ ?' a ? ?el z a A 5;_ ??_ <br />Signature of Co rate O Rcer, Owner, or Designee <br />Date