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v <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Wagner Construction, Inc. <br />M-1999-018 <br />Wagner Rock <br />Apri120, 2003 <br />$281.00 (Due on or before your anniversary date) <br />Moffat <br />RECEIVED <br />APR 0 22003 <br />Division of Minerals and Geology <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 trap showing the extent of current disturbances to affected land, <br />reclamation-acco'mplishe'd io date"and-during the preceding year, new disturbances that are anticipated to occui <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach yrolr revised written anmlal report and anneal rennet man to this fnrm_ Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Jay L. Wagner <br />Permitiee Name: Wagner Construction, Inc. <br />Address; 96400 E. Hwy. 40 <br />Craig, CO 81625 <br />Phone Number: (970) 824-2709 <br />Fax Number: (970) 824-2709 <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 />L. <br />Si re of Corporate Offic ,Owner, or Designee <br />~. ~~~'Ji <br />Date <br />M:~PERM ITMASTERDOCUMENTSUA-AF-01 <br />