2004-07-21_REPORT - M1981276

• Permit No: M1981276
• IBM Index Class Name: Report
• Doc Date: 7/21/2004
• Doc Name: Annual Fee/Report/Map
• From: Wes Hertzog Trucking
• To: DMG
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Wes Hertzog Trucking
M-1981-276
Hertzog Pit
July 22, 2004
f
RECE~~JE1~
JUL 21 2004
Division of Mintlrtlle ~ ~®®I®~Y
$688.00 (Due on or before your anniversary date)
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~ubmi~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 ynnr revised written anneal re~nrt and anneal r~nnrt man 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:
Pennittee Name:
Address:
Phone Number:
Fax Number:
Wes Hertzog
Wes Hertzog Trucking
814 Stout St.
Craig, CO 81625
[phone]
If you have additional comments and/or information that should be provided to the Division, please provide
below or attach it to this form along with your written report and map. Annual Report instructions are enclosed.
f i~~
Signature of Corpor ffi er, O er, or Desire
Date