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<br />111 IIIIIIIIIIIIIlII <br />ANNUAL FEE and REPORT REQUEST <br /> S <br />i <br />P <br />d B <br />i <br />k & Til <br />C REC'EI VED <br />PERMITTEE NAME: umm <br />t <br />resse <br />r <br />c <br />e <br />o. <br />PERMIT NO.: M-1977-325 N~~ 2 s 2QQ~ <br />OPERATION NAME: Cherokee Clay Mine <br />Division of Mineral <br /> <br />ANNIVERSARY DATE: <br />November 23, 2001 s and GeoloBY <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-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 dismrbances 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 vour revised written annual report and annual report map to this form. Please note tlrar art <br />adequately labeled map that clearly delineates mtd includes the above elements may since for a Written report. <br />Division records indicate the following permit[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 it <br />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />Si a re f Corporate Officer or Owner <br />~/-/9" ~-o~( <br />Date <br />M:~PERMITN1 ASTERDOCUMENTSV.1-AF-01 <br />