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iii iiiiuiiniu iii ~ <br />ANNUAL FEE and REPORT REQUEST <br />PERMITI'EE NAME: Summit Brick & Tile Co. ~ECE~VE® <br />PERMIT NO.: M-1998-067 <br />OPERATION NAME: Patton Clay Mine JAN 1 4 2002 <br />ANNIVERSARY DATE: January 13, 2002 Division of Minerals and Geology <br />ANNUAL FEE DUE: $688.00 (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-I 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 />reclamation accomplished [o date and during [he preceding year, new disturbances [ha[ are anticipated [o 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 vour revised written annual reuort and annual resort map to this form. Please Wore that an <br />adequately labeled map that clearly deluteates and inc[urles the above elements may suffice for a written report. <br />Division records indicate the following pertnittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Joseph C. Welte <br />Perrrtittee Name: Sununu 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 />v ~~i' ""` <br />Si a re f Corporate Officer or Owner <br />Dale <br />M ~PERMITV.7ASTERD000A1Em'SUt-AF~01 <br />