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PERMITTEE NAME: Robinson Brick Company RECEIVED <br />PERMIT NO.: M-1993-004 APR 0 92003 <br />OPERATION NAME: Navajo Clay Pit <br />Oiv(sion ~f Minerals anA Geology <br />ANNIVERSARY DATE: May 10, 2003 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Elbert <br />According to C.R.S. 34-32.S-i I6 or C.R.S. 34-32-116, each year, on the.anniversary date of the.permit, an operat_or_ _ _ <br />-shall-submit-the annual-fee,-a report and map showing the extent of current disturbances to affected land, <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please~ttach ynnr revised written annual re2nrt and annual rennrt m ~n to this form- please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Michael G. Leidich <br />Permittee Name: Robinson Brick Company <br />Address: 1845 W. Dartmouth Ave. <br />Denver, CO 80110-1308 <br />~Phone.Number:_, _(303) 783-3047. <br />Fax Number: (303) 781-1818 <br /> <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />Signature of Corporate Officer, Owner, or Designee <br />Date <br />M:IPERMI7lMASTERD000MENTSIM-AF-DI <br />