2005-07-13_REPORT - M1978011

• Permit No: M1978011
• IBM Index Class Name: Report
• Doc Date: 7/13/2005
• Doc Name: Annual Fee/Report/Map
• From: robinson brick company
• To: dmg
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Robinson Brick Company
M-1978-011
Buffalo No 1
August 14, 2005
$688.00 (Due on or before your anniversary date)
Elbert
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~i~isian o! M1lirerals & Geolop y
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
shall-submit-the-annual-fee,,-a-report-and-map-showing-the-extent-of-current-disturbances to affecte8-land,
reclamation accomplished to date and during the preceding year, new disturbances thal:are anticipated to occur
during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning
of active operations, and the date active operations ceased for the year, if any. '
Please attach ynnr revised written anneal rennet and anm~al red nrf mad to this fnr~, Please note that an
adequately labeled map that clearly delineates and includes the above elements may since for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: -Pvliehsel-G-Beidich
Permittee Name: Robinson Brick Company
Address: 1845 W. Darhnouth Ave.
Englewood, CO 80110
Phone Number: ~~1A3}~83-'.,04}-
Fax Number: r'^~'-.a1-1~°:~-
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If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are enclosed.
Signature of Corporate Of to , O•, or Designee
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Date