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~. ` <br />~~ <br />LT7o <br />ANNTiAT, FF.F, and RF.P(1RT RF.OTTFIST <br />REC~11/~® <br />PERMITTEE NAME: Summit Pressed Brick & Tile Co. <br />PERMIT NO.: M-1977-325 NOV 13 ZOaj <br />OPERATION NAME: Cherokee Clay Mine Oivisipn pt Minerals and Ceplpgr <br />ANNIVERSARY DATE: November 23, 2004 <br />ANNUAL FEE DUE: $281.00 (Due ou 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 current disturbances to affected land, <br />reclamation accomplished to date and during the preceding year,-new~ts`turbances tthat are anttcipafed 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 ynnr revised written annnal rennrt and annual re~nrt maT to this form- Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written 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 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 />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 enclosed. <br /> <br />Signa~i e oflCoiporate Officer, Owner, or Designee <br />~/~L y X99 `` <br />Date <br />