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pM~ <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: ~/ /Summit Brick & Tile Co. ~ „'~ '-" "' ~ <br />PERMIT NO.: ~/ M-1977-322 q/ F~`~ ? ~ it ,17 <br />OPERATION NAME: Beaver Crk Clay Mine ~., . _,c , . - . _ lion, <br />ANNIVERSARY DATE: February 17, 2007 1tr11""~ °"- "~•=~7 <br />ANNUAL FEE DUE: $$281.00 (Due on or before your anniversary date) <br />COUNTY: Fremont <br />c <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 p'erfor`med 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. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred durine the previous year and no new changes to <br />the previous year's map are necessary, then no new map is required. provided that the Ouerator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />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 />Permittee 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 />Si lure f Corporate Officer, weer, or Designee <br />~ / mo <br />Dates <br />