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<br />.`~ <br />'C_/ <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: Summit Pressed Brick & Tile Co. R~C' E'vE~ <br />PERMIT NO.: M-1977-325 NQ'J 2 5 ?QOp <br />OPERATION NAME: Cherokee Clay Mine Division of Minerals and Geology <br />ANNIVERSARY DATE: November 23, 2002 <br />ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) <br />COUNTY: Fremont <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-1 l6, each year, on the anniversary date of the permit, an operator <br />- --shall submiC-[he 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 your revised written annual report and annual report man 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 permi[[ee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Joseph C. Welte <br />Permittee Name: Summit Pressed 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 i[ <br />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />Signa of orporate Ol1fficer, Owner, or Designee <br />/' 2' li ©E7 2i <br />Date <br />M:~PERMI7IMASTERD000MENTSN~I-AF-OI <br />