2005-10-24_REPORT - M1977326

• Permit No: M1977326
• IBM Index Class Name: Report
• Doc Date: 10/24/2005
• 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:
ANN~iiAi, FF.F, and RF.PnRT RF.ni1F,ST
Robinson Brick Company
977-326
Siloam Mine
November 23, 2005
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OCT 2 -: 2C05

$225.00 (Due on ar before your anniversary date)
Pueblo
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 khe-annual fee,-a-report-and-map-showing-the-extent-of-current-disturbances-taaffected - -
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 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 anmial report and anneal report main to this form- 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: Marvin R. Meyers, Jr.
Permittee Name: Robinson Brick Company
Address: 1845 W. Dartmouth Ave.
Englewood, CO 80110
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
M:~PERMITMASTERD000MENTS/M-AF-02.DOC