2017-02-24_REPORT - M1975009

• Permit No: M1975009
• IBM Index Class Name: Report
• Doc Date: 2/24/2017
• Doc Name: Annual Fee/Report/Map
• From: The Lakewood Brick and Tile Company
• To: DRMS
• Annual Report Year: 2015
• Email Name: MAC
• Media Type: D
• Archive: No

Page 5 of 5
Division records indicate the following permittee contact information. If this information is not current, please type or
print current contact information:
Permittee Contact:
ThomasJ. Murray
Permittee Company:
The Lakewood Brick and Tile
Company
Address:
1325 Jay St
Lakewood, CO80214
Phone Number:
[phone]
Fax Number:
[phone]
Email Address:
[e-mail]
I, the undersigned, herebX state thayhe information provided in this report is true and accurate, and that site operations are
being conducted in ac c rd ce wA the Division approved mining and reclamation plans.
ofPeEWjqee, Corporate Officer, Owner, or Documented Designee
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Date