2013-12-20_REPORT - M1977252

• Permit No: M1977252
• IBM Index Class Name: REPORT
• Doc Date: 12/20/2013
• Doc Name: Annual Fee/Report/Map
• From: General Shale Brick, Inc.
• To: DRMS
• Email Name: TAK
• Media Type: D
• Archive: No

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13. Is weed control being conducted in accordance with an approved Weed Control Plan? YES NO N/A
If "YES ", indicate the weed species, control area, control type, application rate and treatment ate on the report map.
14. Is adequate topsoil reserved for reclamation, based on your approved permit? YES NO N/A
If "NO ", please explain:
15. Is the reserved topsoil vegetated/stabilized in accordance with Rule 3.1.9(1)? YES NO N/A
If "NO" please explain:
16. If mining has exposed groundwater, is the site in compliance with the approved mining plan and Office of theStaLe
Engineer (Well Permit, S.W.S.P., and/or Permanent Augmentation Plan)? YES NO N/A
17. Are all hazardous materials stored within approved spill containment structures? YES NO N/A
18. Is your financial warranty value sufficient t6 cover the cost to complete reclamation? YES NO N/A
19. Is your basis for legal right to enter still valid? YES NO
20. Does your permit require you to submit monitoring information annually? YES F N/A
If "Yes ", please attach the required monitoring results to this Annual Report.
21. As required by Colorado Mined Land Reclamation Act and/or Colorado Land Reclamation Act for the Extraction of
Construction Materials (C.R.S. 34 -32 -116 or 34- 32.5 -116), attach a map to this report that accurately depicts the
permit boundary, current affected area boundary and location of the acreages specified in items 7- 12 and 14.
UPDATED MAP ATTACHED:
Division records indicate the following permittee contact information. If this information is not current, please type or
print current contact information:
Permittee Contact:
Tony Fabrizio
Permittee Company:
General Shale Brick, Inc.
Address:
1845 W. Dartmouth Ave.
Denver, CO 80110 -1308
Phone Number:
(303) 783 -3041
Fax Number:
(303) 783 -2992
Email Address:
CF.PR.email
I, the undersigned, hereby state that the information provided in this report is true and accurate, and that site operations are
being conducted in accordance with the Division approved mining and reclamation plans.
re of
Owner. or Documented Designee
1Z lq 1 2A17
Date