2017-04-25_REPORT - M1993080

• Permit No: M1993080
• IBM Index Class Name: REPORT
• Doc Date: 4/25/2017
• Doc Name: Annual Fee/Report/Map
• From: The Summit Pressed Brick and Tile Company
• To: DRMS
• Annual Report Year: 2017
• Email Name: TC1
• Media Type: D
• Archive: No

Page 5 of 5
Division records indicate the following permittee/landowner contact information(blank fields indicate that we do not have
information on record). If this information is blank or not current,please type or print current contact information:
Permittee Contact: Jesepk-QWe4e-
i'vl
Permittee Company: The Summit Pressed Brick and
Tile Company
Address: P.O. Box 533
Pueblo, CO 81002-0533
Phone Number: [phone]
Fax Number: [phone]
Email Address: M A -4-14P Ea CX e Caet. 7
Permitting Contact:
Company:
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Address: 79 gS v4 vcC-0ir1VE'5u 17r Za'l�
PPIUAD 4/ C 0 g000~,t
Phone Number:
Fax Number:
Email Address: Grlvi r - 11C CoOu ,A5 i)e
Inspection Contact:
Company:
Address:
Phone Number: -71
Fax Number:
Email Address:
I,the undersigned,hereby state that the information provided in this report is true and accurate, and that site operations are
being conducted in accordance with the Division approved mining and reclamation plans.
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Signature of Permittee,Corporate Officer,Owner,or Documented Designe bate
M-AF-01