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~~~ <br />~/ ANNTIAT. FF.F, and RF.PnRT REQTTF.ST <br />PERMITTEE NAME: ~ The Denver Brick Company <br />PERMIT NO.: ~ M-1997-007 <br />OPERATION NAME: Bijou Clay Mine <br />ANNNERSARY DATE: February 19, 2006 <br />F7EC~I~'~f~ <br />v ~'~8 16 2006 <br />//~ItH61Bfl M Minewls and Geology <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Elbert <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 <br />snau suomu me annual tee, a repon ana map snowing me extent or current aisturoances to auectea Tana, <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 />]~Jease attach xnnr revised written anm~al re_pnrf and annual rennrt mgp fn this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suJ~ce for a written report. <br />Division records indicate the following permittee contact information. Please verify -and make any necessary <br />changes: <br />Permittee Contact: Albert C. Templeton <br />Permittee Name: The Denver Brick Company <br />Address: 401 Prairie Hawk Dr. <br />Castle Rock, CO 80104 <br />Phone Number: (303) 688-6951 - <br />Fax Number: ~30~1}~H8S=5-290 3 0 3 - 6 ~ fr - 98~ 9 `~ <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 enc]osed. <br />Signature of orporate Offic er, or Designee <br />2 ~~ /mar <br />Date <br />