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~F ~ ~~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT RE VEST <br />Seifert Construction <br />M-1999-003 / <br />Tallahassee Pit <br />~~~~~~~ <br />APR 0 7 2008 / <br />Division ut Keelamation, ~('~ <br />Mining and Safety jam' <br />Apri18, 2008 <br />$$323.00 (Due on or before your anniversary date) <br />Fremont <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 showing the extent of current disturbances to affected land, <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 the-beginning _ <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annual report and annual report map to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee report, and associated <br />map. If no new disturbances or reclamation have occurred during the previous year and no new changes to <br />the previous year's map are necessary, then no new map is required, provided that the Operator shall state <br />this in the Annual Report• Please note that an adequately labeled map that clearly delineates and includes the <br />above elements may su f ce for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Je;rald Seifert <br />Permittee Name: <br />Address: <br />Seifert Construction <br />P.O. Box 305 <br />V~Jestcliffe, CO 81252 <br />Phone Number: ('119) 783-2757 <br />Fax Number: <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. , <br />Signature f Corporate Office Own r, or Designee <br />~- ~ ~~ ,~ <br />Date <br />