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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />~~ ; ~'PI <br />ANNUAL FEE and REPORT REQUEST <br />River Bottom Land Corporation <br />1992-100 <br />River Bottom Land Gravel <br />February 5,2007 <br /> <br />/ JAN 2 4 2001 <br />' D' i~iQn of Rr~elamation, <br />Mining and Safety <br />$$281.00 (Due on or before your anniversary date) <br />Delta <br /> <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 preceding year, new disturbances that are anticipated to occur <br />" during [he upcomingyear;-reclamatiocs-that-wiN-be-perfonred•dur-irg-the-coming_year,_the_dates-fncihe_hegitn~iltg= <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annual resort 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 />man. If no new disturbances or reclamation have occurred durinc the previous veer and no new chances 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 sur ice 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 Corporate fir, Owner, or Designee <br />-/`1-0 <br />Date <br />