2003-09-26_REPORT - M1993027

• Permit No: M1993027
• IBM Index Class Name: Report
• Doc Date: 9/26/2003
• Doc Name: Annual Fee/Report/Map
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

J
RECEIVED
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE
ANNUAL FEE DUE:
COUNTY:
Seifert Construction
M-1993-027
Scboolfield Pit
October 4, 2003
$281.00 (Due on or before your anniversary date)
Custer
SEP Z 5 "'3
Oiaision of Minerals and Geology
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,
rest ccm-
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 your revised written annual rennrt and anneal rennrt m ~n to this form. Please note that 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:
Permittee Contact: Mary Seifert
Permittee Name: Seifert Construction
Address: 198 Range View Loop
Phone Number:
Fax Number:
P.O. Box 305
Westcliffe, CO 81252
[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 o Corpo ate Offic r, Owner, or Designee
q'-d ~-o ~
Date
M:~PERMITVv1ASTERDOCUM ENTSV.~I-AF-01