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. ~. ~ RECEIVED <br />JAN 14 2008 <br />nn ~ <br />'~~ ~' K~ Division of declamation, <br />ANNUAL FEE and REPORT REOUl:~n9 and Safety <br />PERMITTEE NAME: Summit Brick & Tile Co. ~~ ~~~~~~~~ <br />PERMIT NO.: M-1998-067 ~ JAN ~ 4 2~9 <br />OPERATION NAME: Patton Clay Mine jai-:N,.~ri of Reclamai,~:k <br />i~1i.;iis,z,~ ~Pw ~ _... <br />ANNIVERSARY DATE: January 13, 2008 <br />ANNUAL FEE DUE: $$791.00 (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 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 />Please attach your 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 />man. If no new disturbances or reclamation have occurred during the previous year and no new chanEes to <br />the previous year's map are necessary, then no new man is reauired, 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. 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 enclosed. <br />~~-~"! <br />Si a re f Corporate Officer, Owner, or Designee <br />2~0~ <br />Date <br />