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~~ ~ <br />s <br />ANN AL FEE and PORT REpUEST <br />PERMITTEE NAME: i The Denver Brick Company <br />PERMIT NO.: /I1-I-1977-392 <br />OPERATION NAME: Dawson Mine <br />ANNIVERSARY DATE: March 11, 2007 <br />ANNUAL FEE DUE: $$688.00 (Due on or before your anniversary date) <br />COUNTY: Elbert <br />4,~,./~p~qR ~ g?Op <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_annuaLSee,_aseport-and_mapshowing_the_extent.o~cur[ent_disturbances to_affected_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 vour revised written annual report and annual report map to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred durinc the previous veer and no new chances to <br />the previous year's map 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: 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: (303) 688-5270 <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 f»t i~long with your written report and map. Annual Report instructions are enclosed. <br />Owner, or Designee <br />Z~v ~O~-/ <br />Date <br />