REP06126

• Permit No: M1998067
• IBM Index Class Name: Report
• Doc Date: 1/22/2004
• Doc Name: 2004 Annual Report
• From: Summit Brick & Tile Co.
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

i.

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY;
Summit Brick & Tile Co.
M-1998-067
Patton Clay Miue
January 13, 2004
$688.00 (Due on or before your anniversary date)
Fremont
RECEIVEp
JAN 2 21004
6lrisian o! Minerals ~ ,
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
shall submit the annual fee, a report and map showing the extent of current disturbances to affected land,
-reclamation accomplished to date and during the preceding year, new-disturbances-that are anticipated to'occur-
during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning
of active operations, and the date active operations ceased for the year, if any.
Please attach your revised written annual rennrt and annual rennrt mad to this form- Please note that an
adequately labeled map that clearly delineates and includes the above elements may suffice for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Joseph C. Welte
Permittee Name: Summit Brick & Tile Co.
Address: P. O. Box 533
Pueblo, CO 81002-0533
Phone Number: [phone]
Fax Number: [phone]
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are enclosed.
Signa ~ e of dorporate Officer, Owner, or Designee
Date
M:\PERM INNASTERDOCUMENTS\M-AF-01