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b~(c.~ <br />'~ ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: '~ Robinson Brick Company <br />PERMIT NO.: ~ M-1977-252 <br />OPERATION NAME: Pioneer Mine <br />ANNIVERSARY DATE: January 13, 2007 <br />ANNUAL FEE DUE: $$688.00 (Due on or before your auniversary date) <br />COUNTY: Douglas <br />rv'~ <br />~l, to-o7 <br />~`a"~'I~~'~.'~t °~i~ <br />~~`~J:,:'i C 9 2006 <br />i/Divie~cr. cF+~~csc.=::cn, <br />lYlli!111y &Ltl ::6:a:`J <br />RECEIVED <br />JAN 0 ~ 2007 <br />Division °land Safety n <br />Mining <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 extent of current disturbances to affected land, <br />reclamation accomplished to date and_during the_preceding_yeaz,_new_disturbances-that-are-anticipated-to-xcur- - <br />during the upcoming year, reclamation that will be performed during the coming yeaz, the dates for the beginning <br />of active operations, and the date active operations ceased for the yeaz, if any. <br />Please attach vour revised written annual report and annual report maa to this form. The Aunual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />maa. If no new disturbances or reclamation have occurred durinc the previous veer and no new chances to <br />the arevious year's mau are necessary. then no new map is reuuired, provided that the Oaerator 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 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. Myers, 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 aze enclosed. <br />UlM <br />Signature of Corpor Offi~ ,Owner, or Designee <br />0 5 ~n~ <br />Date <br />