2008-07-23_REPORT - M2002122

• Permit No: M2002122
• IBM Index Class Name: REPORT
• Doc Date: 7/23/2008
• Doc Name: Annual Fee/Report/Map
• From: Selfert Construction
• To: DRMS
• Permit Index Doc Type: Annual Fee/Report
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
ANNUAL FEE and REPORT REQUEST
Seifert Construction F
M-2002-122
Boyer Pit
July 23, 2008
RECEIVED
JUL 2 3, 2008
DiWsion of Redatnafion,
Mkft and Sak?
$$791.00 (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
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 that are anticipated to occur
during the upcoming yearar rec amatio`n that wi-il-be?perto" rmea duringa coming-year,=?he datesfor - -
of active operations, and the date active operations ceased for the year, if any.
Please attach _your revised written annual report and annual report map to this form. The Annual Report
& Fee requirement is not met until we have received the following components: fee, report, and associated
may. If no new disturbances or reclamation have occurred during the previous year and no new changes to
the previous vear's map are necessarv, then no new man is reauired, provided that the Operator shall state
this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the
above elements may suffice for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Jerald A. Seifert
Permittee Name: Seifert Construction
Address: P.O. Box 305
- - Westcliffe, CO 81252
Phone Number: [phone]
Fax Number: [phone]
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are enclosed.
-4-v"
Signature of orporate Officer, Owner, or Designee
= a a- C)
Date