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. III IIIIIIIIIIIII III <br /> <br />• i~ ~L~a~b i s <br />~~ <br />J :....~ .... <br />ANNUAL REPORT . <br />~~:.I'S ili ~~ <br />PERMITTEE NAME: The Denver Brick Company <br />PERMIT NO.: M-1976-007-UG <br />OPERATION NAME: Golden Mine <br />ANNIVERSARY DATE: October 4, 2000 <br />ANNUAL FEE DUE ON ANNIVERSARY DATE: $281.00 <br />COUNTY: Jefferson <br />~~:c~sv~~~ , <br /> <br />7ivis~c• -.' .~iner~.:. and Geology <br />According to C.R.S. 34-32-116(3)(a), each year, on the anniversary date ~f the permit, an operator shall <br />submit the annual 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 [hat aze anticipated <br />to occur during the upcoming year, reclamation that will be performed during the coming year, the <br />dates for the beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised annual report map and written report to this annual rEDOrt. Please <br />note that an adequately labeled map that clearly delineates and includes the above elements may <br />since for a written report. <br />Please type or print the current contact person's name, mailing address, and phone number in the space <br />provided: <br />Contact Name: Vt/k n e S,m t°~~L t° <br />Add~~r11ess: ,~Cn yrr t~/r//, c.~ ~~~077 . <br />Company: I,en v~~ KJrrG ~nt~a <br />Phone No.: (.3l~3 1 6 s'6 '69S/ <br />FAX No.: (~ 03 1 ~ a'~' ^ ~3"oz 70 <br />e-mail: <br />If there are additional comments and/or information that should be provided to the Division, please <br />provide i[ on a separate sheet and attach it to this report form along with your map and/or written <br />report. <br />G <br />Signature o Corporate Offic , or Owner Date <br />INSTRUCTIONS ON BACK <br />M;~PER M fM/ASTERDOCUMEKr5U1-AF-01 <br />