2005-07-13_REPORT - M1978014

• Permit No: M1978014
• IBM Index Class Name: Report
• Doc Date: 7/13/2005
• Doc Name: Annual Fee/Report/Map
• From: robinson brick company
• To: dmg
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Robinson Brick Company
M-1978-014
North Chieftain
August 14, 2005

JNL 13 2005
Division of Mlinera~s & Gc0108Y
$688.00 (Due on or before your anniversary date)
Jefferson
According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an operator
-- shall-submit-the-annual-fee,-a-report-and-map-showing-the-extent-of-current-disturbances-to-affected land,--
reclamation accomplished to date and during the preceding yeaz, new disturbances that are anticipated to occur
during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning
of active operations, and the date active operations ceased for the year, if any.
Please attach your revised written anmral report and annnal renrnrt m~ to this fo~7, Please note that an
adequately labeled map that clearly delineates and includes the above elements may since for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: rt;^>,°Pi r. r ^;d;ch
Permittee Name: Robinson Brick Company
Address: 1845 W. Dartmouth Ave.
~,. „ P
Englewood, CO 80110-000
Phone Number: X303}.783-304 , ~ 3- 3 -.3<^f,'/~
Fax Number: r'n"?O1 ' °7 4 3 - ,~,~
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report inshvctions are enclosed.
ature of Corporate Offic , O , or Designee
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Date