2014-08-01_REPORT - M1978014

• Permit No: M1978014
• IBM Index Class Name: REPORT
• Doc Date: 8/1/2014
• Doc Name: Annual Fee/Report/Map
• From: General Shale Brick, Inc.
• To: DRMS
• Permit Index Doc Type: Annual Fee/Report
• Email Name: MAC
• 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 /A
If"YES", indicate the weed species,control area, control type, application rate and treatment date on the repo 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)? OYES 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 the State
Engineer(Well Permit, S.W.S.P., and/or Permanent Augmentation Plan)? YES NO
17. Are all hazardous materials stored within approved spill containment structures? YES NO N/A
18. Is your financial warranty value sufficient to cover the cost to complete reclamation? ES 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 NO 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 ar a.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: [phone]
Fax Number: [phone]
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 ' ccordance with the Division approved mining and reclamation plans.
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ignature of Permittee,Coro ate Officer,Owner,or Documented Designee D to