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o/-1"- <br /> <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />r ? <br />ANNUAL FEE a/L2PORT REQUEST <br />Denver Brick Company <br />kZ2-007-009 <br />Kiowa Clay Mine <br />August 6, 2008 <br />$$791.00 (Due on or before your anniversary date) <br />Elbert <br />RL-: <br />4UG 0 2008 <br />®itfwcn W F' ectemagion, <br />7'v 0 i aRd szq <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 rep7ort-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 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: 4ohn-eurvr <br />? <br /> <br />Permittee Name: ea-?n i <br />The Denver Brick Company <br />mss -- ?Jl'?Ds??r: SIT .x, T)r <br /> Castle Rock, CO 80109 <br />Phone Number: (303) 688-6951 <br />Fax Number: (303) 688-9894 <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