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bm/: <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Cherokee Clay Mine <br />November 23, 2009 <br /> <br /> <br />$$323.00 (Due on or before your anniversary date) <br />Fremont <br />o/<:-, <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_occ.ur <br />durin the upcoming reclamation that will be performed during the coming year, the dates for the beginning <br />year, 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 />map. If no new disturbances or reclamation have occurred during the previous year and no new changes to <br />the iprevious year's map are necessary, then no new map is required, 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 />Perfnittee Contact: Joseph C. Welte <br />Permittee Name <br />Address: <br />Phone Number: <br />Fax, Number: <br />Summit Pressed Brick & Tile Co. <br />P.O. Box 533 <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 enclosed. <br />Signa re d Corporate Officer, Owner, or Designee <br />Date <br />?F <br />ANNUAL FEE and REPORT QUEST <br />Summit Pressed Brick & Tile Co. <br />//M-1977-325