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.~ <br />ANNUAL FEE and TORT REQUEST <br />PERMTfTEE NAME: ~ummit Brick & Tile Co. ~~/`~~ +g '~D <br />PERMIT NO.: M-1977-320 ~JUSL.eO P ~/ <br />OPERATION NAME: 8-Mile Clay Mine 3 2~~) <br />~ision of Reclamation, <br />ANNNERSARY DATE: June 29, 2007 Mining and Safety <br />ANNUAL FEE DUE: $$688.00 (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 />`sltatt"submit-thc-animal-fee; -a-report-end-map.shavring<fhe-e~ctenEOf-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 />& Fee requirement is not met until we have received the following <br />maa. If no new disturbances or reclamation have occurred durine 1 <br />The Annual Report <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please w~fy aad~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 81002-0533 <br /> <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 />beloyc~or attach it to this form along with your written report and map. Annual Report'i`nstructions are enclosed. <br />Date <br />i <br />