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/f/ ANNUAL FE9and REPORT REQUEST <br />flec"Wo <br />PERMITTEE NAME: 1T The Denver Brick Company <br />MAR 12 2010 <br />PERMIT NO.: /M-1977-392 <br />OPERATION NAME: Dawson Mine DW"n of Reclatnabon, <br />,? ?mmg and Safety <br />ANNIVERSARY DATE: March 11, 2010 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Elbert <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 coming year, the dates f6r the begm`ning - - <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach vour 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 vear'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: Robert Tibbetts <br />Permittee Name: The Denver Brick Company <br />Address: 401 Prairie Hawk Dr. <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 />-??? a 3,,2oIQ <br />Date