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~~ ~ <br />bv~~ <br /> ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: / <br />Summit Pressed Brick & Tile Co. <br />PERMIT NO.: / <br />/ M-1977-325 <br />OPERATION NAME: Cherokee Clay Mine <br />ANNIVERSARY DATE: November 23, 2006 <br />ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) <br />COUNTY: 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 cun•ent disturbances to affected ]and, <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 report and annual report map 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 previous year's map are necessary, then no new map is required, provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. <br />changes: <br />Permittee Contact: Joseph C. Welte <br />Permittee Name: Summit Pressed 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 />Please verify and make any necessary <br />~~~r-~~ <br />d t~~-J 22006 <br />;/uivision ci R ;;anoaGOn, <br />Mrning and 5ateiy <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 you~~r~writ~ten~report and map. Annual Report instructions are enclosed. <br />Signatm f rporate Officer, Owne , or Designee <br />2 / 2006 <br />Date <br />