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~, -, 1/ <br />ANNiJAi. FFF, and RF,PnRT RF.~IJF.RT cc c <br />PERMITTEE NAME: Summit Brick & Tile Co. ~eCEO~E® <br />PERMIT NO.: M-1977-322 FEB 18.1003 <br />OPERATION NAME: Beaver Crk Clay Mine Division of Minerals artd Geology <br />ANNIVERSARY DATE: February 17, 2003 <br />ANNUAL FEE DUE: $281.00 (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 [he permit, an operator <br />shall submit the atmual 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 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 attachynur revised written anm~al rennrt and annual reQnrt maQ to this form- Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written report. <br />Division records indicate the following pemuttee 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 andlor 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 />Q2~ ~ ~r4't~f <br />Sign re f Corporate Officer, caner, or Designee <br />~l ~i~~©3 <br />Date <br />M:~PERMITMASTERD000MENTSVA-AF-01 <br />