2001-04-09_REPORT - M1999018

• Permit No: M1999018
• IBM Index Class Name: Report
• Doc Date: 4/9/2001
• Doc Name: Annual Fee/Report Notice
• Permit Index Doc Type: ANNUAL FEE / REPORT
• Media Type: D
• Archive: No

III IIIIIIIIIIIII III
ANNUAL FEE and REPORT REOUEST
RECEIVLzD
PERMITTEE NAME: Wagner Construction,Inc.
PERMIT NO.: M-1999-018 APR 0 9 2001
OPERATION NAME: Wagner Rock Division of Minerals and Geology
ANNIVERSARY DATE: April 20,2001
ANNUAL FEE DUE: $281.00(Due on or before your anniversary date)
COUNTY: Moffat
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 shall submit the annual fee, a report and map showing the extent of current disturbances to affected
-land, reclamation-accomplished to date-and-during the-preceding year,new-disturbances that-are-anticipated to —
occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the
beginning of active operations, and the date active operations ceased for the year, if any.
Please attach your revised written annual report and annual report map to this form. Please note that an
adequately laheled neap that clearly delineates and includes the above elements may suffice for a written
report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Jay L. Wagner
Permittee Name: Wagner Construction, Inc.
Address: 96400 E. Hwy. 40
Craig, CO 81625
Phone Number: [phone]
Fax Number: [phone]
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are
enclosed.
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nature of Corporatey1ficer or Owner
Date
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