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~f',`r <br />/laleg pue 6uiw~y <br />'uogewe~^~~ }o i~~~sinip <br />;/ ANNUAL FEE and REPORT REQUEST /(OOZ [ ~ Nd~ <br />PERMITTEE NAME: I/ /Summit Brick & Tile Co. ~ ~~/~l~:F3~ <br />PERMIT NO.: i/ M-1998-067 <br />OPERATION NAME: Patton Clay Mine <br />ANNIVERSARY DATE: January 13, 2007 <br />ANNUAL FEE DUE: $$688.00 (Due on or before your anniversary date) <br />COUNTY: Fremont <br />of i~-off <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 precedingyeaz,~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 acfive operations ceased for the year, if any. <br />Please attach your revised written annual report and annual report man to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred durinc the previous year and no new chances to <br />the arevious year's map are necessary, then no new man is required, provided that the Ouerator shall state <br />this in the Annual Resort. Please note that an adequately labeled map that clearly delineates and includes the <br />above elements may suff ee for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Petmittee Contact: Joseph C. Welte <br />Perrrtittee 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 <br />below or attac'hA/it to this fofyrAm///a/lon~g with your written report and map. Annual Report instructions are enclosed. <br />Sign re o Corporate Officer, Owne , or Designee <br />~~~~ <br />Date <br />