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-..: ~` <br />ANNUAL REPORT <br />PERMITTEE NAME: The Denver Brick Company <br />PERMIT NO.: M-76-007-UG <br />OPERATION NAME: Golden Mine ' ~~ <br />ANNIVERSARY DATE: October 04, 1999 fit(, 1 '3 x'90. <br />ANNUAL FEE DUE ON ANNIVERSARY DATE: $225.00 -•^7 ^1~InB~~i. - <br />COUNTY: Jefferson <br />According to C.R.S. 34-32-1 16(3)(x), 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 <br />to afiec[ed land. reclamation accomplished to date and during the preceding year, nee, <br />disturbances that are anticipated to occur during the upcoming year, reclamation that will be <br />performed during the coming year, the dates for the beginning of active operations, acid the date <br />active operations ceased for the year, if any. <br />Please attach your revised annual report map and written report to this <br />annual report. Please note drat an adequately labeled map thnr clearly delineates and <br />includes the abore elements may suffice for n written report. <br />Please type or print the current contact person's name, mailing address, and phone nr.mber in the <br />space provided: <br />Contact Name: 1 ~ B~~c ~ <br />Address: ~e~t ~ ~.-• I1.7 ~i c ~ ~o i <br />~O (~oX /6 do <br />GB5 1 ~G ~OL~, C~ ~~`~~ <br />Company: ,(,~t?ri/er X-3r ~ ~ ~ L D i <br />Phone No.: (j~ 3 ) ~lf~ 6 9,y / <br />Fax No.: (303 ) 6~~' .5'~a 7b <br />If there are additional comments and/or information that should be provided to the Division, <br />please provide i[ on a separate sheet and attach it to this report form along with your map and/or <br />written report. <br />Sig atur~ ora[ fficer, or Owner Dale <br />INSTRUCTIONS ON BACK <br />