2017-04-11_REPORT - M1999003

• Permit No: M1999003
• IBM Index Class Name: Report
• Doc Date: 4/11/2017
• Doc Name Note: Annual Report and Map
• Doc Name: Annual Fee/Report/Map
• From: Seifert Construction dba Seifert Enterprises, LLC
• To: DRMS
• Annual Report Year: 2017
• Email Name: TC1
• Media Type: D
• Archive: No

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.Q. k - J
14$ e W ew Lc>y
Westcliffe, CO 81252 /
Phone Number: [phone]
Fax Number: [phone]
Email Address:
Inspection Contact: Trenton Stafford
Company: Seifert Construction
Address: P-O ftux-2-10 M e V i tW Lc)- ,to
Westcliffe, CO 81252 /
Phone Number: [phone]
Fax Number: [phone]
Email Address: O'd 6 5(OCOP"�1 C S•Co/vt
I,the undersigned, hereby state tl at 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