2007-04-18_REPORT - M1999018 - Laserfiche WebLink

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PERMITTEE NAME: PERMIT NO.: OPERATION NAME: ANNIVERSARY DATE ANNUAL FEE DUE: COUNTY: ANN F~E antl REPORT REQUEST Wagner Construction, Inc. M-1999-018 Wagner Rock Apri120, 2007 $$281.00 (Due on or before your anniversary date) Moffat ~~~ P'0 ~, . 7,100>',~ v •ri `' `'y p? 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-Ohe-ceding-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 -- ofactive operations, and the date active operations ceased for the year, if any. Please attach vour revised written annual resort and annual resort maa to this form. The Annual Report & Fee requirement is not met until we have received the following components: fee, report, and associated ma . If no new disturbances or reclamation have occurred durinti the previous vear and no new chanties to the urevious year's map are necessary, then no new map is reuuired, provided that the Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the above elements may since 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: (970) 824-2709 Fax Number: (970) 824-2709 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. Si ature of Corporate O ~cer, Owner, or esignee Date