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R~' ~ ~ <br /> ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: Robinson Brick Company <br />PERMIT NO.: M-1980-245 <br />OPERATION NAME: Hogback Mine <br />ANNIVERSARY DATE: February 10, 2008 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Douglas <br />RECEIVE® <br />FEB 0 5 ZQO~ ~~/ <br />Division ofi keciamation V <br />Mining and Safety <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;-rew dist~zrban;,es-that-are-ar:ti^,ipate3- 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 your 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 during the previous year and no new changes 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 suffice 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 />Phone Number: <br />Fax Number: <br />Denver, CO 80110-1308 <br />(303) 783-3046 <br />(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 Report instructions are enclosed. <br />Signature of Corporate Officer, Owner, or Designee <br />Date <br />