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1W * Rv(T- <br />,ANNUAL FEE and REPORT REOUEST <br />PERMITTEE NAME: .7 River Bottom Land Corporation <br />PERMIT NO.: ? M-1992-100 <br />OPERATION NAME: River Bottom Land Gravel <br />ANNIVERSARY DATE: February 5, 2010 <br />ANNUAL FEE DUE: $323.00 (Due on or before your anniversary date) <br />COUNTY: Delta <br />RECEIVED <br />L--/ FEB 012010 <br />I Division ur r<eclamation, <br />Mining and Safety <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- -during-the preeeding year,- 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 may 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 since 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: River Bottom Land Corporation <br />Address: 175 Highway 133 <br />Paonia, CO 81428 <br />Phone Number: (970) 527-4434 <br />Fax Number: (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 /> <br />of Corporate Officer, Owner, or Designee <br />- Z k-16) <br />Date