2008-08-14_REPORT - M1997039

• Permit No: M1997039
• IBM Index Class Name: REPORT
• Doc Date: 8/14/2008
• Doc Name: Annual Fee/Report/Map
• From: Wyatt Redi-Mix Co
• To: DRMS
• Permit Index Doc Type: Annual Fee/Report
• Media Type: D
• Archive: No

A?-s '4- 0-r
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
ANNUAL FEE and REPORT REOUEST
Wyatt 12MLMig Co L54'0

M-1997-039

WilliamsAMinois Gravel Pit
August 12, 2008
$323.00 (Due on or before your anniversary date)
Jackson
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AU G 14 2008 ?
iaivisiad1 01
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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 thepr?uling 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 your revised written annual report and annual reuort may to this form. The Annual Report & Fee
requirement is not met until we have received the following components: fee. report. and associated may. If no
new disturbances or reclamation have occurred during the previous vear and no new do M to the previous
;ear's map are necessary. then no new map is required, 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
sufce for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary changes:
Permittee Contact: Richard F. Wyatt
Permittee Name:
Address:
Wyatt Redi-Mix Co
P.O. Box 1052
Walden, CO 80480
Phone Number: [phone]
Fax Number: [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.
Signature of Corporate 6 cer, Owner, or Designee
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Da
/UP