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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />r <br />d REPOR REOUES' <br />Shale Brick, Inc. dba Robinson Brick Div. <br />M-1978-009 <br />Apache 9 <br />August 14, 2010 <br />$$791.00 (Due on or before your anniversary date) <br />El Paso <br />dmk °? <br />AUG 03 2010 <br />i%Asa0n of RockaNkUn. <br />Hniryl and $00i <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 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: Tony Fabrizio <br />Permittee Name <br />General <br />Shale <br />Brick, <br />Inc. <br />dba Robinson Brick CB0i?vM-dun `? <br />Address: 1845 W. Dartmouth Ave. <br />Denver, CO 80110-1308 <br />Phone Number: (303) 783-3046 (303) IS3 - 3 0+1 <br />Fax Number: (303) 781-1818 .? 231 83 -,9,9 <br />If you have additional comments and/or information that should be <br />below or attach it to t ' form along with your written report and map. <br />gnature of Corp at Officer, Owner, or Designee <br />0 La 6 <br />Date <br />provided to the Division, please provide it <br />Annual Report instructions are enclosed.