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ti <br />.. <br />r <br />/~ <br />FiECEPVE® <br />/FEB 2 1 2006 <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />/ANNiiAi. FF,F. and RF,POAT RF.QiiF.ST <br />mmit Brick & Tile Co. <br />M-1977-322 <br />Beaver Crk Clay Mine <br />February 17, 2006 <br />vDivisian of Minerals and Geology <br />$281.00 (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 _ ~ <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 <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annual reFnrt and anmral re,Qn rt marn to this form- Please note that an <br />adequately labeled map that clearly delineates and includes the 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-OS33 <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 />Yl <br />Corporate Officer, Owner, or Designee <br />Date <br />