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_ • : ~ILL3~ ~ X281 ~ <br />~ III IIIIIIIII'II~ III <br />sss <br />ANNUAL REPORT <br />PERMITTEE NAME: Mike Coleman and Jerry Seifert o. ~~~1 <br />PERMTf NO.: M-1993-027 '~'°0 00~ ~~.~ <br />'. <br />OPERATION NAME: Schoolfield Pit o~~'%%~, yc'~ ~`°~ <br />J~ C~ <br />ANNNERSARY DATE: October 4, 2000 ~°a <br />ANNUAL FEE DUE ON ANNNERSARY DATE: $281.00 ~ o <br />9i <br />COUNTY: Custer <br />According to C.R.S. 34-32-116(3)(a), each year, on the anniversary date of the permit, an operator shall <br />submit [he annual fee, a report and map showing the extent of current disturbances to affected land, <br />reclamation accomplished to date and during the preceding year, new disturbances [hat are anticipated <br />to occur during the upcoming year, reclamation that will be performed during the coming year, the <br />dates for the beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach Your revised annual report map and written report to this annual report. Please <br />note That an adequately labeled map that clearly delineates and includes the above elements may <br />since for n written report. <br />Please type or print the current contact person's name, mailing address, and phone number in the space <br />provided: <br />Contact Name: Mary Seifert Company: Seifert Construction <br />Address: P.O. Box 305 Phone No.: (719 ) 783-2757 <br />Westcliffe, CO 81252 FAX No.:( ) same <br />e-mail: <br />If there are additional comments and/or information that should be provided to the Division, please <br />provide it on a separate sheet and attach it to this report form along with your map and/or written <br />report. <br />~ l; -,~, -c~~ <br />Signature of Corpo ate Offic r, or Owner Date <br />INSTRUCTIONS ON BACK <br />M:~PERM ITV.1 ASTER DOCUMEM'SVv1-A F-01 <br />