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ANei Fr and REPORT REQUEST RECEIVED <br />PERMITTEE NAME: `The Denver Brick Company MAR 41 6 2009 <br />M-1977-392 Division of Reclamation, <br />PERMIT NO.: 4O Mining and Safety <br />OPERATION NAME: Dawson Mine <br />ANNIVERSARY DATE: March 11, 2009 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Elbert <br />0l< <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, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be performed during the con ing-year, tare uutes for-tile-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 <br />Permittee Name <br />Address <br />Phone Number: <br />Fax Number: <br />-?Ie,k '"j 1?,4f3 <br />The Denver Brick Company <br />401 Prairie Hawk Dr. <br />Castle Rock, CO 8010 <br />(303) 688-6951 <br />99W <br />(303) 688-=Ba? <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 />nA/rT 9 <br />Signature of Corporate Officer, Owner, or Designee <br />- '4 ' <br />Date