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' y / « • • <br />ANNUAL FEE and REPORT REQUEST <br />RECEIVED <br />PERMITTEE NAME: Summit Brick & Tile Co. FEg Z 0 2~~~ <br />PERMIT NO.: M-1977-322 <br />Oivisian of Minerals and Geology <br />OPERATION NAME: Beaver Crk Clay Mine <br />ANNIVERSARY DATE: February 17, 2001 <br />ANNUAL FEE DUE: $28].00 (Due on or before your anniversary date) <br />COUNTY: Fremont <br />According to C.R.S. 34-32.5-I 16 or C.R.S. 34-32-i 16, each year, on the anniversary date of the pemtit, 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 resort man to this form. Please note that mt <br />ndequate!}~ labeled map [hut clearly delineates and includes the above elements tray 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. Wel[e <br />Permittee Name: Summit Brick & Tile Co. <br />Address: P.O. Box X33 <br />Phone Number: <br />Fax Number: <br />Pueblo, CO 81002-0533 <br />(719)542-8278 <br />(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 />~~ <br />Signa e o Corporate Officer or Owner <br />a/~ /nor <br />Date <br />M NERMnVNASTERDOCIJNfENTSN1-AF-~I <br />