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ANNUAL FEE and REPORT REQUEST <br />PERMTI'TEE NAME: Robinson Brick Company <br />PERMIT NO.: M-1991-003 <br />OPERATION NAME: Tomahawk Mine <br />ANNIVERSARY DATE: April 26, 2007 <br />ANNUAL FEE DUE: $$688.00 (Due on or before your anniversary date) <br />COUNTY: Pueblo <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 ]and, <br />_ reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />during the upcoming year,-reclamation tKafwil]-be perfoi7tted-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 annual report and annual report man to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, reuort, and associated <br />map. If no new disturbances or reclamation have occurred durinc the previous year and no new chances to <br />the previous year's man are necessary, then no new map is required. provided that the Operator 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. (Ric) Myers, Jr. <br />Permittee Name: Robinson Brick Company <br />Address: 1845 W. Darhnouth Ave. <br />Denver, CO 80110-1308 <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 />