REP11073

• Permit No: M1977251
• IBM Index Class Name: Report
• Doc Date: 2/19/2003
• Doc Name: Annual Report
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

ANNUAL FEE and REPORT REQUEST
PERMITTEE NAME:
Robinson Brick Company
RECEIVE®
PERMIT NO.:
OPERATION NAME:
M-1977-251
Lariat Pit
ANNIVERSARY DATE: March 5, 2003
FEB 192003
Oivisien of Minerals and Geology
ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date)
COUNTY: Jefferson
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 eztent'of current disturbances to affected land,
reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur
during the upcoming year, reclamation that will be performed during the coming yeaz, the dates for the beginning
of active operations, and the date active operations ceased for the year, if any.
Please attach vour revised written annual report and annual resort maa 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 petmittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Michael G. Leidich
Permittee Name: Robinson Brick Company
Address: 1845 W. Dartmouth Ave.
Denver, CO 80110-1308
Phone Number: [phone]
Fax Number: [phone]
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 instructions are enclosed.
Signature of Corporate Officer, Owner, or Designee
Date
MiPERMITNIASTERDOCUMENTSN-I-AF-01