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aF ~- ~P~ <br /> ANNUAL FEE and REPORT REQUEST <br /> ~~ <br />PERMITTEE NAME: Acme Brick Compa <br />ny <br />PERMIT NO.: / <br />M-1989-052 / <br />OPERATION NAME: Dakota Clay Pit <br />ANNIVERSARY DATE: October 25, 2007 <br />ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date) <br />COUNTY: Jefferson <br />/i'~ <br />RECEIVED <br />OCT 19 2007 <br />Division of Redamatlan, <br />Mining and Safely <br />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 <br />- shall submit the annual-fee; a report and map showing the-exierit 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 attach your revised written annual report and annual resort mao to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred during the previous year and no new chances to <br />the previous year's mao are necessary. then no new map is required, provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />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: Albert Templeton <br />Pennittee Name: Acme Brick Company <br />Address: C/O Acme Brick -Denver <br />401 Prairie IIawk Dr. <br />Castle Rock, CO 80109 <br />Phone Number: (303} 688-6951 <br />Fax Number: (303) 688-5270 <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 fomra~ong with your written report and map. Annual Report instructions are enclosed. <br />Signature of Corporate Off er, Owner, or Designee <br />~/~~~ <br />Date <br />Office of~ <br />