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ANNUAL FE ~ahd REPORT REpUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Summit Brick & Tile Co. <br />`~M-1985-203 <br />Edmondson Clay Mine <br />May 9, 2007 <br /> <br />v-4T~rP~/~'-, <br />1J' l C Z~~ <br />r,~~,.,., ~ -.~ <br />$$281.00 (Due on or before your anniversary date) <br />Pueblo <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 ]and, <br />reclamation accomplished to date and during the preceding year,-new- disturbances that_are anficipated_ to occur <br />during the upcoming year, reclamation that will be performed during the coming yeaz, 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 reuort 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 durinc the previous year and no new chances to <br />the_previous year's map are necessary, then no new moo is required, provided that the Operator shall state <br />this in the Annualthis in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />above elements may since 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 />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />~ ~~ ~~~ <br />Borate Officer, Offer, or Designee <br />Sly l 2-0 0 <br />Date <br />