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Permittee Contact: <br />Joseph C. Welte <br />Permittee Company: <br />Summit Brick & Tile Co. <br />Address: <br />P.O. Box 533 <br />Pueblo, CO 81002 -0533 <br />Phone Number: <br />(719) 542 -8278 <br />Fax Number: <br />(719) 542 -5243 <br />Email Address: <br />CF.PR.email <br />&vIXD SPeGCS - CI'lN►4b<1 MI5 TMe, $ccTGN 7 / cTLe / MvSr - r - t i 7L - <br />C carrZot- 4/rex) - 5,-' Sre+i''1U 6 p1M , f <br />c /roc TYPE — S aPo T GPe47 /A4. w ,714 /v)1 sroxvE Halt zlci O 4.' -- Q 50a0:Ac-TAiuT Page 3 of 3 <br />e}pIA-i (agTc" - $ Fly Ib Cc u S pct AC P.' aF ,viis 570,+e <br />-- Tarr rim t DAMS - /nAy /o4 2o/Z. d- DC 7l>t3e R_ a nd, 2osZ <br />13. Is weed control being conducted in accordance with an approved Weed Control Plan? NO N/A <br />If "YES ", indicate the weed species, control area, control type, application rate and treatment date on the report map. <br />14. Is adequate topsoil reserved for reclamation, based on your approved permit? <br />If "NO ", please explain: <br />15. Is the reserved topsoil vegetated /stabilized in accordance with Rule 3.1.9(1)? <br />If "NO" please explain: <br />Wie Coo <br />Signature of Permittee, Corporate Officer, Owner, or Documented Designee <br />NO N/A <br />NO N/A <br />16. If mining has exposed groundwater, is the site in compliance with the approved mining plan and Office of the State <br />Engineer (Well Permit, S.W.S.P., and /or Permanent Augmentation Plan)? YES NO <br />17. Are all hazardous materials stored within approved spill containment structures? YES NO <br />18. Is your financial warranty value sufficient to cover the cost to complete reclamation? NO N/A <br />19. Is your basis for legal right to enter still valid? ® NO <br />20. Does your permit require you to submit monitoring information annually? YES (1 10) N/A <br />If "Yes ", please attach the required monitoring results to this Annual Report. <br />21. As required by rule, attach a map to this report that accurately depicts the permit boundary, current affected area <br />boundary and location of the acreages specified in items 7- 12 and 14. UPDATED MAP ATTACHED: A <br />Division records indicate the following permittee contact information. If this information is not current, please type or <br />print current contact information: <br />I, the undersigned, hereby state that the information provided in this report is true and accurate, and that site operations are <br />being conducted in accordance with the Division approved mining and reclamation plans. <br />/ /c. <br />Date <br />