2007-04-09_REPORT - M1999003

• Permit No: M1999003
• IBM Index Class Name: Report
• Doc Date: 4/9/2007
• Doc Name: Annual Fee/Report/Map
• From: Jerald Seifert and Fred Lowry
• To: DRMS
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

ANNUALIlE and ~ PORT REQUEST
PERMITTEE NAME:
PERMTT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
~ Jerald Seifert and Fred Lowry
~M-1999-003
Tallahassee Pit
April 8, 2007
~~

APR 0 9 2001
~ivision of Reclamation,
PAining and Safety
$$281.00 (Due on or before your anniversary date)
Fremont
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 cun•ent disturbances to affected land,
-reclamation-accomplishedlo..date and during the preceding year, new disturbances that are anticipated to occur
during the upcoming year, reclamation that will be performed during the coming year; the3ate's for the`beginning----
ofactive operations, and the date active operations ceased for the year, if any.
Please attach your revised written annual report and annual report map to this form. The Annual Report
& Fee requirement is not met until we have received the following components: fee, report, and associated
IDap. If no new disturbances or reclamation have occurred durinc the previous vear and no new chances to
the previous year'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 suffice far a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact:
Permittee Name:
Address:
Phone Number:
Fax Number:
Mar Seifert //
Jerald Seifert and Fred Lowry
P.O. Box 305
Westcliffe, CO 81252
[phone]
(719}783-2988
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 o Corpor toO-f~ficer Owne , or Designee
Date