2005-06-30_REPORT - M1977320

• Permit No: M1977320
• IBM Index Class Name: Report
• Doc Date: 6/30/2005
• Doc Name: Annual Fee/Report/Map
• From: summit brick and tile co.
• To: dmg
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Summit Brick & Tile Co.
M-1977-320
8-Mile Clay Mine
June 29, 2005
$688.00 (Due on or before your anniversary date)
Fremont
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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
shall submit the annual fee, a report and map showing the extent of current disturbances to affected land,
reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur
during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning
of active operations, and the date active operations ceased for the year, if any.
Please attach your revised written anm~al renrnrt and annnal rennrt mad to thic form. Please note that an
adequately labeled map that clearly delineates and includes the above elements may suffice for a rvritten report.
Division records indicate the following petmittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Joseph C. Welte
Permittee Name: Summit Brick & Tile Co.
Address: P.O. Box 533
Pueblo, CO 81002-0533
Phone Number: [phone]
Fax Number: [phone]
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instmctions are enclosed.
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Si ture of Corporate Officer, Owner, or Designee
Date?