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ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: Summit Brick and Tile Co. ~ECE~ VE~ <br />PERMIT NO.: M-1977-317 DEC 16 2002 <br />OPERATION NAME: Cedarwood Clay Mine <br />ANNIVERSARY DATE: December 15, 2002 Division of Minerals and Ceelogy <br />ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) <br />COUNTY: Pueblo <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-] 16, 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 />reclamanan accomp[istied ro 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 [he date active operations ceased for the year, if any. <br />Please attach your revised written annual report and annual resort mau 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 />Permi[tee Contact: Joseph C. Welte - <br />Permittee Name: Summit Brick and Tile Co. <br />Address: P.O. Box 533 <br />Pueblo, CO 31002-0533 <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 i[ to [his form along with your written report and map. Annual Report instructions are enclosed. <br />Signat of orporate Officer, Owner, or Designee <br />Date <br />M;IPERMnVNASTERDOCUMEN7SUI-AA-01 <br />