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' • IIIIIIIII99IIIIIIIII 34339R�C�/ .1 I� <br /> F <br /> JAN 12 <br /> D <br /> visi <br /> D; ?0p1 <br /> ANNUAL FEE and REPORT REQUEST on of4finera/saedGeolojf <br /> PERMITTEE NAME: Summit Brick & Tile Co. <br /> PERMIT NO.: M-1998-067. <br /> OPERATION NAME: Patton Clay Mine <br /> ANNIVERSARY DATE: January 13,2001 <br /> ANNUAL FEE DUE: $688.00 (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 <br /> operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br /> land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br /> occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br /> beginning 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 man to this form. Please note that an <br /> adequately labeled map that clearly delineates and includes the above elements may suffice for a written <br /> 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 /> Perm ittee 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 /> below or attach it to this form along with your written report and map. Annual Report instructions are <br /> enclosed. <br /> I <br /> Sign a of rorporate Officer or Owner <br /> - A) - , <br /> Date <br /> M APE RM ITMASTERDOCUNENTSW-AF-0I <br />