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ANNUAL FEE and REPORT REQUEST RECEIV,Ep <br />PERMITTEE NAME: Jerald Seifert and Fred Lowry APR 0 8 2002 <br />PERMIT NO.: M-1999-003 Division of Miner <br />l <br /> a <br />s and Geelagp <br />OPERATION NAME: Tallahassee Pit <br />ANNPJERSARY DATE: April 8, 2002 <br />ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) <br />COUNTY: Fremont <br />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 <br />shall submit the annual fee, a report and map showing the extent of current disturbances [o affected land, <br />reelamation-accomplished-to da~e-and'during'the-prez eding year; new disturlianc`es tlia[ aPe `anticipated-to occur ~' - <br />during the upcoming year, rectamatian that will be performed during [he coming year, [he dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annual resort and annual report mau to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Mary Seifert <br />Permittee Name: Jerald Seifert and Fred Lowry <br />Address: P.O. Box 305 <br />Westcliffe, CO 81252 <br />Phone Number: (719) 783-2757 <br />Fax Number: _ (7]9)783_2757 - - - _ _ _ 719-783-2988__ __ __ __ _ _,_ _._. <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instmctions are enclosed. <br />_ .Q/ <br />Si afore of Corporate Officer or caner <br />~~ 7 -C7 cr~ <br />Date <br />M:NERMrRMASTERDOCUMEMSIM-AF-01 <br />