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RECEIVED <br />JUN 1 4 2002 ~- <br />PERMITTEE NAME: <br />PERMIT' NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Seifert Construction <br />M-1985-040 <br />Seifert Pit <br />June 18, 2002 <br />Division of Minerals and Geology <br />$688.00 (Due on or before your anniversary date) <br />Custer <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each yeaz, on the anniversary date of the permit, an operator <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for [he beginning <br />of active operations, and the date active operations ceased for [he year, if any. <br />Please attach your revised written annual report and annual resort map 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 />Pernilttee Contact Mary Seifert <br />Permittee Name: Seifert Construction <br />Address: P.O. Box 305 <br />Phone Number: <br />Fax Number: <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 />l.J~ p~ <br />Signature of Corporate Officer or Owner <br />(fl - ~l-~ ~ <br />Date <br />M:~PERMI'1 VNASTERDOCUMENTSVvt-AF-OI <br />