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/ANNUAL FEE and REPORT REQUEST _ <br />PERMITTEE NAME: / Robinson Brick Company r/ ()~'~ ; 9 ?~n~ <br />PERMIT NO.: ~M-1977-326 t/Division of Reclamation, <br />OPERATION NAME: Siloam Mine Mining and Safety <br />ANNNERSARY DATE: November 23, 2006 <br />ANNUAL FEE DUE: $225.00 (Due on or before your anniversary date) <br />COUNTY: Pueblo <br />io <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 <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning 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 <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated map. If no new disturbances or reclamation have occurred durinti the arevious year and no <br />new chanties to the previous year's map are necessary, then no new map is required, provided that the <br />Ouerator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />delineates and includes the 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 />J e~5 <br />Permittee Contact: Marvin . Meye r. <br />Pennittee 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 aloi3g~W~h your written report and map. Annual Report instructions are <br />of Corporate Of~cer,/C~(vner, or Designee <br />Date <br /> <br />M:~PERMII1MASrEADOCUMENTS/M-AF-02.DOC <br />