2001-12-07_REPORT - M1982015

• Permit No: M1982015
• IBM Index Class Name: Report
• Doc Date: 12/7/2001
• Doc Name: Annual Fee/Report/Map
• Permit Index Doc Type: ANNUAL FEE / REPORT
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
'I~ ! ~~"III~~
ANNUAL FEE and REPORT REQUEST
Siegrist Construction Company
M-1982-015
Siegrist Const Co
December 10, 2001

RECEIVED
DEC 01 2001
piviaion of Minerals and Geole9Y
$688.00 {Due on or before your anniversary date)
Weld
According to C.R.S. 34-32.5-I 16 or C.R.S. 34-32-1 l6, 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,
reclamation accomplished to date and during the preceding year, new disturbances [hat 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 vour revised written annual report and annual report map to this form. Please note thnt 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:
Permi[tee Contact: Mike Siegrist
Permittee Name: Siegrist Construction Company
Address: 875 W. 64th Ave.
Phone Number:
Fax Number:
If you tpye-38th'
below attach it
Denver, CO 80221
[phone]
[phone]
tal comments and/or information that should be provided to the Division, please provide it
this form along with your written report and map. Annual Report instructions are enclosed.
Si~rtature of Corporate Officer or Owner
;i/.~lG~
Date
M IPERMrIN1A5TERD000 MENTSNI~AF-01