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�II �I�III'I�II�I <br /> ANNUAL FEE and REPORT REQUEST RECEIVED <br /> PERMITTEE NAME: Summit Brick& Tile Co. JUN 2 9 2001 <br /> PERMIT NO.: M-1977-320 Division of Minerals and Geology <br /> OPERATION NAME: 8-Mile Clay Mine <br /> ANNIVERSARY DATE: June 29,2001 <br /> ANNUAL FEE DUE: 6 ,Qt$358 98(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 <br /> operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br /> land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br /> occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br /> beginning of active operations, and the date active operations ceased for the year, if any. <br /> Please attach Your revised written annual report and annual report map to this form. Please note that an <br /> adequately labeled map that clearly delineates and includes the above elements may suffice for a written <br /> 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&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 <br /> enclosed. <br /> - 4ty a / " "i6— <br /> Sign ure f Corporate Officer or Owner <br /> G�Z <br /> Dates <br /> M\PERMITMASTERDOCUMENTSVA-AF-01 <br />