2015-07-04_REPORT - M2011015

• Permit No: M2011015
• IBM Index Class Name: REPORT
• Doc Date: 7/4/2015
• Doc Name: Annual Report & Map
• From: Seifert Enterprises
• To: DRMS
• Email Name: TOD
• Media Type: D
• Archive: No

Page 5 of 5
Division records indicate the following permittee contact information. If this information is not current, please type or
print current contact information:
Permittee Contact:
TrentStafford
Permittee Company:
Seifert Enterprises, LLC
Address:
198 Rangeview Loop
P.O. Box 210 Remove
Westcliffe, C081252
Phone Number:
[phone]
Fax Number:
Email Address:
[e-mail]
I, the undersigned, hereby state that the information provided in this report is true and accurate, and that site operations are
being conducted in accordance with the Divis� approved mining and reclamation plans.
7/22/2015
Signature ofPermittee, Corporate Officer, Owner, or Documented Designee Date
M -AF -01