2015-08-10_REPORT - M2007009

• Permit No: M2007009
• IBM Index Class Name: REPORT
• Doc Date: 8/10/2015
• Doc Name: Annual Fee, Report & Map
• From: Denver Brick Co.
• To: DRMS
• Email Name: AME
• Media Type: D
• Archive: No

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Division records indicate the following permittee contact information. If this information is not current, please type or
print current contact information:
Permittee Contact:
Robert Tibbetts
Permittee Company:
The Denver Brick Company
Address:
401 Prairie Hawk Dr.
Castle Rock, CO 80109
Phone Number:
[phone]
Fax Number:
[phone]
Email Address:
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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.
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Signature of Permittee. Corporate Officer, Owner, or Documented Designee
M -AF -01
Iowa—
Date