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• iii iiiuiiiiiiii iii <br />ANNUAL REPORT <br />PERMITTEE NAME: Mike Coleman and Jerry Seifert <br />PERMIT NO.: M-91-083 <br />OPERATION NAME: Ula Pit <br />ANNIVERSARY DATE: October 29,1999 <br />ANNUAL FEE DUE ON ANNIVERSARY DATE: $225.00 <br />COUNTY: Custer <br />• ~i <br />;._ ~ Ij <br />_~~~~; <br />OCT 0 5 1999 <br />oivision ollylnerale 6 Geoy9Y <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 annual fee, a report a^.d map showing the extent of current disturba.^.ces <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 />performed during [he coming yeaz, 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 an adequately lnbe(ed rnnp thur clearly delinentes and <br />includes the above elements may suffice for a 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 1Vame: Ma r~. Sri fart <br />Address: <br />P.O. Box 305 <br />___ Westcliffe, Co. 81252 _ <br />Company: Custer County Concrete <br />Phone No.: ( 719- ~ 783-9041 <br />Fax No.: ( 719 ~_ 783-2757 <br />If there a~'e additional cornments and/or information that should be provided to the Division, <br />please provide it on a sepazate sheet and attach it to this report form along with your map and/or <br />written report. <br />~,~~-q~ <br />S' nature of Corporate Offi er, or Owner Date <br />INSTRUCTIONS ON BACK / <br />