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L <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br /> <br />Summit Brick & Tile Co. <br />M-1998-067 <br />Patton Clay Mine <br />January 13, 2003 <br />$688.00 (Due on or before your anniversary date) <br />Fremont <br />RECEIVED <br />JAN 13 2003 <br />Division of Mineral3 and Geology <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 />- -r 6lamation accomplished-to date-and during the preceding year`, new dislu~bances [ at are anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, [he dates for [he beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attash your rPVised written anneal report and anneal re op rt man to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Pemuttee Contact: Joseph C. Welte <br />Permittee Name: Summit Brick & 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 />Q 'l4~~U/~/Zif <br />to Officer, Owner, or signee <br />fl ~zon 3 <br />Date <br />M 1PERMmN1ASTERD000MENTSUI-AF-01 <br />