2006-03-16_REPORT - M1977392

• Permit No: M1977392
• IBM Index Class Name: Report
• Doc Date: 3/16/2006
• Doc Name: Annual Fee/Report/Map
• From: The Denver Brick Company
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
V ANNTIAi. FF.F. and REPORT RF.OTiF.ST
~ The Denver Brick Company
M-1977-392
Dawson Mine
March 11, 2006
RECEIVECa
~ MAR 16 20D6
'~ Division ~f Minerals and Geolosy
$688.00 (Due on or before your anniversary date)
Elbert
According to C.R.S. 34-32.5-I 16 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,
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.
Pleacr attach ~gnr revised written annnal rennrt and anm~al repnrf man to this form. Please note that an
adequately labeled map that clearly delineates and includes the above elements may suffice for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Albert C. Templeton
Permittee Name: The Denver Brick Company
Address: 401 Prairie Hawk Dr.
Castle Rock, CO 80104
Phone Number: [phone]
Fax Number: [phone]
If you have additional comments and(ot 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 instructions are enclosed.
Signature of Corporate O r, Owner, or Designee
3/G ~~
Date