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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE; <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Summit Brick & Tile Co. <br />M-1977-219 <br />Fox No.1 Clay Pit <br />March 22, 2003 <br />RECE°" ~~~ <br />MAR Z 4 i,uu3 <br />Bfvision of Minerals and GealosY <br />$688.00 (Due on or before your anniversary date) <br />Pueblo <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-Tee; a report and m`ap Sliowing`the eztenf of current`disturba'nces 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 resort and annual resort mao to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the 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 />•G~ <br />Signa re o Corporate Officer, Own r, o Designee <br />7~1~003 <br />Date <br />MiPERMITMASTERDOCUMENTSU-7-AF-0t <br />