2017-02-21_M1999003_Annual Fee Notice ARCHIVE

• Permit No: M1999003A
• IBM Index Class Name: Report
• Doc Date: 2/21/2017
• Doc Name: Annual Fee Notice
• From: DRMS
• To: Seifert Construction dba Seifert Enterprises, LLC
• Annual Report Year: 2017
• Media Type: D
• Archive: Yes

Page 5 of 5

Division records indicate the following permittee/landowner contact information (blank fields indicate that we do not have
information on record). If this information is blank or not current , please type or print current contact information:

Permittee Contact:

Trenton Stafford
Permittee Company:

Seifert Construction dba Seifert
Enterprises, LLC

Address:

198 Range View Loop
Westcliffe, CO 81252

Phone Number:

[phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact:

Trenton Stafford
Company:

Seifert Construction
Address:

P.O. Box 210
Westcliffe, CO 81252

Phone Number:

[phone]
Fax Number: [phone]
Email Address:
Inspection Contact:

Trenton Stafford
Company:

Seifert Construction
Address:

P.O. Box 210
Westcliffe, CO 81252

Phone Number:

[phone]
Fax Number: [phone]
Email Address:

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 Division approved mining and reclamation plans.

Signature of Permittee, Corporate Officer, Owner, or Documented Designee Date
M-AF-01