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<br />~ /"`~ <br />PERMITTEE NAME: Robinson Brick Company J~11V f i ,,, <br />X445 <br />PERMIT NO.: M-1977-252 Q1JlSIOn ot~inerals fH fauloOV <br />OPERATION NAME: Pioneer Mine <br />ANNNERSARY DATE: January 13, 2005 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Douglas <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 />__ `shalLsubmit_the_annual_fee,_a_reporLand_ruap_showing,the_extenLof_current_dishubances_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 ynnr revised written anm~al rennrt and anneal re~pnrt man~tn this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffcefor 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 andlor 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 />