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iii iiiiiiiiiiiiiiii • <br />ANNUAL REPORT <br />PERMTI'TEE NAME: Summit Brick & Tile Co. ~ECE~VE~ <br />PERMIT NO.: M-1998-067 JAS 1$ 2~~~ <br />OPERATION NAME: Patton Clay Mine <br />Oivisoon of Alinerale & Geobgy <br />ANNNERSARY DATE: January 13, 2000 <br />ANNUAL FEE DUE ON ANNNERSARY DATE: $550.00 ~ <br />~? ~~,, <br />,.. <br />COUNTY: Fremont ~ "~ ~` <br />® ~. <br />According to C.R.S. 34-32-1 I6(3)(a), each year, on the anniversary date of the permit, an operator shall <br />submit the annual fee, a report and-map showing the extent of current disturbances to affected land, - <br />reclamation accomplished to date and during [he preceding year, new disturbances that are anticipated <br />to occur during the upcoming year, reclamation that will be performed during the coming year, the <br />dates for the beginning of active operations, and the date active operations ceased for the yeaz, if any. <br />Please attach your revised annual report map and written report to this annual report. Please <br />note that an adequately labeled map that clearly delineates and includes the above elements may <br />suffice for a written report. <br />Please type or print the current contact person's name, mailing address, and phone number in the space <br />provided: <br />Contact Nam/~e: W~t,~~-f G ~/t/Fi G 1 rv <br />Address: {'. ~~ .~oX S33 <br />~yf~gL.o , co ~/ova ~bS33 <br />Company: S c~/A/!1 /% ~`~/c!~ ~TicE Co <br />Phone No.: (7/ %) .~4~~-- &~ 7d' <br />FAX No.: (~/~ ) SyoZ -So2 c/~ <br />If there are additional comments and/or information [hat should be provided [o the Division, please <br />provide it on a sepazate sheet and attach it to this report form along with your map and/or written <br />report. <br />Signat of rporate Officer, or Owner Date <br />INSTRUCT/ONS ON BACK <br />M iPERMi"I V.IASTERD000MEI~fI'SU7-AF~01 <br />