REP00022 ‎(2)‎

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
ANNUAL FEE and REPORT REQUEST
RECEIVED
APR 2 9 2Q "2
Division of Minerals and Geology
Summit Pressed Brick & Tile Co.
M- 1993 -080
Callum Clay Pit
April 26, 2002
$688.00 (Due on or before your anniversary date)
El Paso
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
shall submit the annual fee, a report and map showing the extent of current disturbances to affected land,
-- — reclamation accomplished =to-d'af� and ` during -ifia preceding year`, new`distdibances [ha[ are anticipated to occur
during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning
of active operations, and the date active operations ceased for the year, if any.
Please attach your revised written annual report and annual report map to this form. Please note that an
adequately labeled map that clearly delineates and includes the above elements may suffice for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Joseph C. Welte
Permittee Name: Summit Pressed Brick & Tile Co.
Address: P.O. Box 533
Pueblo, CO 81002 -0533
Phone Number: (719) 542 -8278
Fax Number: (7542 -5243
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are enclosed.
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Signat r of olporate Officer or Owner
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