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p,~ (`' <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 anniversary date) <br />COUNTY: Douglas <br />Dl. to-07 <br />~`~J.;'~r C 9 2006 <br />imi;:u.y and oc,,;.j <br />12ECEIVED <br />JAN 0 ~ 2001 <br />Division o'a d 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_year,_new_disturbances-that-are-anticipated-to-occur- - <br />during the upcoming yeaz, 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 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 />maa. If no new disturbances or reclamation have occurred durinc the previous year and no new chances to <br />the arevious year's maa are necessary, then no new map is required, urovided 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 Repor[ instructions are enclosed. <br />lM <br />Signature of Corpor e Offi ,Owner, or Designee <br />~11~5~~ <br />Date T <br />