Laserfiche WebLink
.. <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />Robinson Brick Company <br />M-1981-148 <br />Chieftain South Mine <br />November 1, 2004 <br />$688.00 (Due on or before your anniversary date) <br />Jefferson <br />l ~1 <br />~t.,;`i:~~. <br />r~U,! U 3 2C0~} <br />7iviaioa at iviinaral~ C Caala~;+ <br />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 <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />reclamation accomplished"to date'and duting the preceding y`earr,^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 anneal report and anneal re nr~~t _map to Chic form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Marvin R. Meyers, Jr. <br />Permittee Name: Robinson Brick Company <br />Address: 1845 W. Dartmouth Ave. <br />Englewood, CO 80110 <br />Phone Number: (303) 783-3046 <br />Fax Number: (303) 783-2992 <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 form along with your written report and map. Annual Report instructions are enclosed. <br />Signature of Corporate Officer, Owner, or Designee <br />Date <br />