2006-04-10_REPORT - M1999018

• Permit No: M1999018
• IBM Index Class Name: Report
• Doc Date: 4/10/2006
• Doc Name: Annual Fee/Report/Map
• From: Wagner Construction Inc
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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(/ ANNTTAI. FF.F, and RF.PCIRT RF,OTJF.ST
~~~E~VED
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Wagner Construction, Inc.
//M-1999-018
Wagner Rock
April 20, 2006
~~~~~
~bivision of Minaralaand Geology
$281.00 (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 submit the annual fee, a report and ~nap~hawing_the_extenLof r,,,rPr,+ disturbances-to-affected-land, _-
reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur I
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 rennrt and anneal re o~ rt man to this form. 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:
Fax Number:
[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 instructions are enclosed.
Sign a of Corporate ficer, Owner, or Designee
Date