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<br />ANNUAL FEE and REPORT REQUEST <br />RECEIlJE® <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />~. <br />APR 2 9 ZQ"3 <br />Division of Minerals and Geolaoy <br />Summit Pressed Brick & Tile Co. <br />M-1993-080 <br />Calhan Clay Pit <br />April 26, 2002 <br />$688.00 (Due on or before your anniversary date) <br />EI Paso <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 repoR and map showing the extent of current disturbances to affected land, __ <br />- -- -reclamation accomplished=to-d'at~ and`during-ilia p~ecefling year`, new`distdibances [ha[ 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 vour revised written annual reuort and annual reuort maa to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written report. <br />Division records indicate [he following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Joseph C. Welte <br />Pertriittee Name; Summit Pressed Brick & Tile Co. <br />Address: P.O. Box 533 <br />Pueblo,CO 81002-0533 <br />Phone Number: (719) 542-8278 <br />Fax Number: (7542-5243 <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 farm along with your written report and map. Annual Report instructions are enclosed. <br />Signat r of o~porate Officer or Owner <br />~ ~o~S~~02 <br />Date ~--~ <br />M: W ERMITUTASTERDOCUM ENTS~M-AF-OI <br />