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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />~-F:~~~ <br />ANNUAL FEE and REPORT REQUEST <br />~ Summit Brick & Tile Co. <br />~" M-1977-321 <br />Native/Pierre Mine <br />February 17, 2008 <br />1~~~i~' ~/ ~® <br />FEB 19 2008 <br />ivision or rcLC~amation, <br />Mining and Safety <br />$$323.00 (Due on or before your anniversary date) <br />Pueblo <br /> <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 fo 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 vour revised written annual report and annual report man 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 durin the revious ear and no new chap es to <br />the previous year's map are necessary, then no new man is required provided that the Operator shall state <br />this ~n 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: <br />Fax Number: <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 enclosed. <br />Si e of Corporate Officer, weer, or Designee <br />2 / ~ 2nog <br />Date <br />