REP45052

• Permit No: M1990016
• IBM Index Class Name: Report
• Doc Date: 1/5/2005
• Doc Name: Inadequate Annual Fee/Report
• From: DMG
• To: High Plains Stone Company
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

ANNUAL FEE and REPORT REQUEST
PERMTI"PEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
High Plains Stone Company
M-1990-016
South 40 Quarry
July 11, 2004
$281.00 (Due on or before your anniversary date)
Fremont
According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each yeaz, 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 aze 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 yeaz, if any.
Please attach your revised written annual report and annual report map to this form. Please note that an
adequately labeled map 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:
Permittee Name:
Address:
Phone Number:
Fax Number:
Scott Wagner
High Plains Stone Company
P.O. Box 100
Castle Rock, CO 80104
[phone]
[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 instrucfions aze enclosed.
Signature of Corporate Officer or Owner
Date