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r <br />k <br />AN AL FEE and PORT REQUEST <br />PERMITTEE NAME: Summit Brick & Tile Co. P cEIVED <br />PERMIT NO.: I-1977-320 t ium 2,j OPERATION NAME: 8-Mile Clay Mine Znpivision of Pecl: MBtl®n, <br />ANNNERSARY DATE: June 29, 2010 TV Mining & *,n"* <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`wljj-tye-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 />map. If no new disturbances or reclamation have occurred during the previous year and no new changes to <br />the previous 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 />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 />40?g (? N?e& <br />6 L,7-,5-1 <br />Date <br />be or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />Si ture of Corporate Of <br />caner, or Designee