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-•. <br /> <br />ANNUAL REPORT <br />PERMITTEE NAME: Seifert Construction <br />PERMIT NO.: M-1985-040 <br />® ~ <br />OPERATION NAME: Seifert Pit <br />ANNNERSARY DATE: June 18, 2000 <br />ANNUAL FEE DUE ON ANNNERSARY DATE: $550.00 <br />COUNTY: Custer <br /> <br />o;~s~ono~ b ~ ~ 0 <br />`~ 40 <br />~~erg/S~G~O <br />'~y <br />~~I ~I~~I~~~~~~~~I~~ <br />According to C.R.S. 34-32-116(3)(a), each year, on the anniversary date of the permit, an operator shall <br />submii the 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 that 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. P/ense <br />note that cm nrlequnte[y labeled mnp thnt clenrly de/irteates and includes the above elements may <br />suffice 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•0. liox 305 Phone No.: (719 ) 783-2757 <br />Westcliffe. CO. 81252 FAX NO.: ( ) same <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 />Signa re of Corporate Officer, o Owner <br />6-26-00 <br />Date <br />INSTRUCTIONS ON BACK <br />A1:~PERM ITNIASTERDOCUMEKI'SN7-AF-01 <br />