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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Summit Brick and Tile Co. <br />M-1977-317 <br />Cedarwood Clay Mine <br />December 15, 2003 <br /> <br />RECE-~Ef~ <br />DEC ~ 6 2003 <br />~on~fMlnarels and QeoloOY <br />$281.00 (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 operatQr__- <br />shall submit the annual_feeTa_report-and-map-showing-the-ex~en o~disturbances to affected land, _ <br />_ -reclamation accomplished to-date and-during tfie preceding year-, new disYurtiances that are anticipated to occur J <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 anneal rennrt and anneal rennrt m ~n 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 and 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 />Signatu o Corporate Officer, O ter, or Designee <br />y-/Z -~~ <br />Date <br />M:~PERMITU-IASTERDOCUM ENTSVN-AF-01 <br />