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~ 5 ' <br />Ali'NUAf,FTi'F.an~7,P17R'~j~i~TPF.CT RECEIVED <br />PIiR&I1TT1:.E NAME: Wagner Construction, Inc. MAY 3 ~ ZOOS <br />PERMI"i' NQ: M-1999-OIS <br />Dlwsron of Mlnerels and Geobyy <br />OPERATION NAME: Wagner !tack <br />ANNIVERSARY DATE: Aprf] 20, 2005 <br />ANNCJAL FEE DUE: ffi281.00 (Due on ur before your anniversary dale) <br />COUNTX: Moffat <br />According to C.R.S. 34-3?.5-1 lb or C.R_S. 34-32-i ifi, each }year, on the anniversary date ofthe permit, an operator <br />shall submit the annual fee, a report and map showing the extent of current dlsturbanees w affcutcd land, <br />reciatnation,accompliShest_ta..date.and dwing the..preceding year, new disttirkanees that~are an{icipated-to occur <br />during the upcoming ycsir, reolamution that will be performed during the coming year, the dates fnr the beginning <br />of active operations, and the date activt operations ceased for the year, if any. <br />~ieace atfarh ynnr r__ vii, aeti }yri fen inn gal rPgnri Ind anntiti 1 rannrt n_an~n tht_'c t_ im p(e4Se not8 that an <br />adegaeately labeled map that clearly delineates and Includes aJ~e above elF~rnents may since for a written report. <br />Dtvtsion records ~ <br />changes: ~ 8517 <br />~~~.~~~c <br />PemtitteeContact: OONSLRUClYQ ~~' ~-.~.Q~'' 9z•rsannzl <br />~~rE <br />96aoCRAIG W OP~,AD~ B1 ~~ <br />PermitteeName: ~~ ~,~/~~~ _~~___~ $ i~f.3~ ~ <br />Address: ~ <br />Y;;a;-. <br />D /~ ~~ nC1LL1K_ S au§.. <br />900 YAMPa AVENYH <br />GFA~t6/. CC 918Pb fA J/ <br />' . ana!$9blU~S7, ~yN~'(/dG ~,~! ;~~g~~~~ ~C!~` .._ __ xr <br />Phone Number: ~ -..~~_^. -'._ _>,_ <br />,, t:io21a154a~.><2n31k2006 .36~85i7 __,_ <br />Fax Number: <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 tnap. Annual Report instructions are enclosed. <br /> <br />azure of Corporate>9Ufficer, Owner, or i)esignee <br />Date <br />