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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />The Denver Brick Company <br />M-1989-052 <br />Dakota Clay Pit <br />October 25, 2003 <br />piuision of Minerals and Geo ogy <br />$281.00 (Due on or before your anniversary date) <br />Jefferson <br />RECEIVED <br />OCT~6Z~~ <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 />sha]!-submit-the-annual-~~--a-report-and-map-sheaving the-estent-ef-eutTer.fdis~,ba..czs-iv-a ccted-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 ynnr revised written annnal rennet and annnal re nn rt man to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the 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 />itt <br />t <br />t <br />P <br />C $ <br />'i ~ U~ <br />C I <br />erm <br />on <br />ac <br />: <br />ee ar5s <br />~ c <br /> //~~ <br />Permittee Name: The Denver Brick Company ~CIM ," - /J ,~ ve f <br />Address: 401 Prairie Hawk Dr. <br /> Castle Rock, CO 80104 <br />Phone Number: (303) 688-6951 C K ~PnSitu # 3Q - <br />Fax Number: (303) 688-5270 <br />If you have additional comments and/or information that should be <br />below or attach it to this form along with your written report and map. <br />Signature of Corporate Officer, Owner, or Designee <br />Date <br />provided to the Division, please provide it <br />Annual Report instructions are enclosed. <br />M:~PERMINAASTERD000MENTSVvI-AFA7 <br />