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. • III IIIIIIIIIIIII III • . <br />-•~ 1 X111 <br />ANNUAL REPORT <br />PERMITTEE NAME: Seifert Construction ~~ <br />~• ~ <br />PERMIT NO.: M-85-040 Fr 9 <br />~9 ~ <br />OPERATION NAME: Seifert Pit* ~ V~ 10. 9 &G~~ <br />ANNNERSARY DATE: June 18,1999 , o,:~~'~sa~ <br />ANNUAL FEE DUE ON ANNIVERSARY DATE: $550.00 ~sa~~ <br />COUNTY: Custer <br />According to C.R.S. 34-32-116(3)(a), each year, on the anniversary date of the permit, an <br />"operator shall submit the annua] fee, a report and map showing the extent of current disturbances <br />to affected land, reclamation accomplished to date and during the preceding year, new <br />disturbances that are anticipated to occur during the upcoming year, reclamation that will be <br />perforn~ed during the coming year, the dates for the beginning of active operations, and the date <br />active operations ceased for the year, if any. <br />Please attach your revised annual report map and written report to this <br />annual report. Please note that nn adequately labeler! map that clearly delineates and <br />includes the above elements may suffice_for n. written report. <br />Please type or print the current contact person's name, mailing address, and phone number in the <br />space provided: <br />Contact Name: Marv Seifert <br />Address: r n_ u~x 3n5 <br />iffe. CO 81252 <br />Company: Seifert Construction <br />Phone No.: (719 ) 783-2757 <br />Fax <br />If there are additional comments and/or information that should be provided to the Division, <br />please provide it on a separate sheet and attach it to this report form along with your map and/or <br />written report. <br />D /~.lr~ri <br />Sign ure of Corporate Office , or Owner <br />6-8-99 <br />Date <br />INSTRUCTIONS ON BACK <br />