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RECEIVED <br />JUN 112003 <br />ANNiJAi. FFF, and REPORT RFniiF.ST Division dMinerals and Geology <br />PERMITTEE NAME: Seifert Construction <br />PERMIT NO.: M-1985-040 <br />OPERATION NAME: Seifert Pit <br />ANNIVERSARY DATE: June 18, 2003 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date} <br />COUNTY: Custer <br />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 <br />shall submit the annual fee, a report and map showin>; the extent of current distwbances~q affected_land. <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated [o occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach ynnr revised written anneal rennH and anm~al rp,Pnrt man to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Mary Seifert <br />Permittee Name: Seifert Construction <br />Address: P.O. Box 305 <br />Phone Number: <br />Fax Ntunber: <br />Westcliffe, CO 81252 <br />(719)783-2757 <br />(719) 783-2757 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />Signature of orpora e Officer, weer, or Designee <br />~Q-ICI-O~ <br />Dale <br />M:\PERMITMASTERDOC UMENTS\M-AF-01 <br />