2004-07-22_REPORT - M2002122

• Permit No: M2002122
• IBM Index Class Name: Report
• Doc Date: 7/22/2004
• Doc Name: Annual Fee/Report/Map
• From: Seifert Construction
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMTf NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Seifert Construction
M-2002-122
Boyer Pit
July 23, 2004
S `~
JUL 2 2 2004
Division of Minerals & Geology
$688.00 (Due on or before your anniversary date)
Custer
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,
rec amanon accomp ~s a t-lid o date and- unng t e prece mg year, new disturbances that are anticipated io 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 ynnr revised written anneal report and anneal rennrt maTfn this form. Please note thal an
adequately labeled map that clearly delineates and includes the above elements may suffice for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Pennittee Contact: Jerald A. Seifert
Permittee Name: Seifert Construction
Address: 198 Range View Loop
P.O. Box 305
Phone Number:
- Fax Number:
Westcliffe, CO 81252
[phone]
[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 f Corpoi to Offic a, Owner, or Designee
`)-d-1~~'-1
Date