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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNfVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />~, ~ ,.-~ 7 <br />C{ r]~~1-6 <br />r->.~ <br />ANNUAL FEE and REPORT REQUEST ~~,, <br />t/ Summit Brick & Tile Co. ~ /~ FF® 2~ ~ D~~~~ <br />/ M-1977-324 v ~t~•'-~ ~20~J <br />' ~ G <br />Stocks Clay Mine <br />February 17,2007 <br />1~hgplS' u'iiU ~ :.r~/2it0,~~ <br />$$688.00 (Due on or before your anniversary date) <br />Fremont <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 _ I <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 performed during the coming year, the dates for the beginning I <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 reuort map to this form. The Annual Report <br />& Fee requirement is not met until we have received the Following components: fee, resort, and associated <br />mau. If no new disturbances or reclamation have occurred durinc the previous year and no new chances to <br />the urevious year's mau are necessary, then no new map is required. urovided that the Operator shall state <br />this in the Annual Reuort. Please note that an adequately labeled map that clearly delineates and includes the <br />above elements may suffice 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 <br />below or attach it tno this form along with your written report and map. <br />~/ <br />Si tur of Corpo/r/ate Officer, O er, or Designee <br />~.~ ~~0 7 <br />Date I <br />provided to the Division, please provide it <br />Annual Report instructions are enclosed. <br />