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Permittee Name: Lakewood Brick and Tile Co. Page 3 <br />Permit No: M-79-045 <br />Operation Name: Church Pit <br />Anniversary Date: 02 / 28 / 92 <br />Map, and a check for $430.00 to cover the Annual Fee. Please sign <br />below to indicate your receipt of this Annual Report, Map and the <br />Annual Fee. Please return it to Environment, Inc., at 7985 Vance <br />DR., Suite 205 A, Arvada, CO 80003. <br />Respectfully Submitted, <br />LAKEW OD BRIC AND 'BILE COMPANY <br />~ ~n~// <br />1~a7Y.l~ ' ~~ ~ <br />homas J. Murray, <br />Vice President <br />RECEIPT <br />RECEIVED this day of , 1992 <br />Annual Report, Annual Report Map and Check <br />#iTa sau 55 from Lakewood Brick and Tile Company. <br />By <br />MINED LAND RECLAMATION <br />cc Charles and Perry McRay, Church Ranch <br />Raren Helner, Jefferson County Planning <br />Coal Creek Sand and Gravel <br />Steve O'Brian, Environment, Inc. <br />File <br />