2005-09-21_REPORT - M1993027

• Permit No: M1993027
• IBM Index Class Name: Report
• Doc Date: 9/21/2005
• Doc Name: Annual Fee/Report/Map
• From: Seifert Construction
• To: DMG
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Seifert Construction
vM-1993-027
Schoolfield Pit
October 4, 2005
n~~
RECEf~~~;~
~EP 212005
70 Division vt Minerals ar;: uen?cp~~
$281.00 (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
shalt subriiit [he annual fee; a report and map'showtng the extent of current disturbances to affected lahd, -
reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to 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 yr.nr revised written anneal rennrt and anneal re~nrt m to this form. Please note Lhat an
adequately labeled map that clearly delineates and includes the above elements may since for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Penrtittee Contact:
Permittee Name:
Address:
Mary Seifert
Seifert Construction
198 Range View Loop
P.O. Box 305
Westcliffe, CO 81252
Phone Number: [phone]
Fax Number:
If you have additional comments and/or information that should be provided to the Division, please provide
below or attach it to this form along with your written report and map. Annual Report instructions are enclosed.
Signature of C rporate fficer, O er, or Designee
°~- ~~ OS
Date