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<br /> <br />PERMI'f'I'EE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Summit Brick & Tile Co. <br />M-1977-322 <br />Beaver Crk Clay Mine <br />February 17,2002 <br />$281.00 (Due on or before your anniversary date) <br />Fremont <br />RECEIVED <br />FEB 192002 <br />Division of Minerals and GeelogY <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 vour revised written annual report and annual report map to this form. Please note that all <br />udeyuatcly labeled ntup that c[carly delineates and includes the above e[emeltts may stffice for « Ivritten report. <br />Division records indicate [he following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Ioseph C. Welte <br />Permittee Name: '. Summit $ridk & Tile Co. <br />Address: P.O. Box 533 <br />Pueblo, CO 81002-0533 <br />Phone Number: (719) 542-8278 <br />Fax Number: (719) 542-5243 <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 />~ ~, <br />.~ <br />Si a[u e of Corporate Officer or Owner <br />2-lisl~o ~- <br />Date <br />M:WERMITMASTERD000MENTSUI-AF-01 <br />