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'~J <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />River Bottom Land Corporation <br />M-1992-100 <br />River Bottom Land Gravel <br />February 5,2005 <br />~R,~'C~~~~® <br />Diuisieno ,r J , `O~ <br />t M~nerets end Ceptegy <br />$281.00 (Due on or before your anniversary date) <br />Delta ~ S' S <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 />„-reclama[inn_accnu~plished_tQdate_and during the precedng_year, new disturbances that are anticipated to occu_r_ _ <br />during the upcoming yeaz, reclamation that will be performed during the coming yeaz, the dates for the beginning <br />~of active ouerations_and-the date.actixe_oneratiortis-ceased-foxttarveaX..if_anv. - -- -- ---- - <br />Please attach ynnr revised written annnal rennrt and anm~al report m to this form- Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may su~ee 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 Hwy. 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 />Signature of Corpora~wner, or Designee <br />-a ~ o~- <br />Date <br />