2011-08-01_REPORT - M1978009 (3)

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PERMITTEE NAME: PERMIT NO.: OPERATION NAME: ANNIVERSARY DATE: ANNUAL FEE DUE: COUNTY: Permittee Contact: Tony Fabrizio Address: 1845 W. Dartmouth Ave. Phone Number: Fax Number: t\) ign ture f Corp ate 03 ati /Qui) Dat Denver, CO 80110 -1308 (303) 783 -3046 (303) 781 -1818 ANl UAL FEE and REPORT REQUEST 'L 3 neral Shale Brick, Inc. dba Robinson Brick Div. • M- 1978 -009 1978 -009 Apache 9 August 14, 2011 $$791.00 (Due on or El Paso ficer, Owner, or Designee 5ECEIVED AUG 012011 - 'jDivision of ReaarnatiOrb before your anniversary date) Mining and y 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 shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, — reclamation - accomplished to -date and - during the preceding year, new disturbances -that -are-anticipated-to -occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning of active operations, and the date active operations ceased for the year, if any. Please attach your revised written annual report and annual report map to this form. The Annual Report & Fee requirement is not met until we have received the following components: fee, report, and associated map. If no new disturbances or reclamation have occurred during the previous year and no new changes to the previous year's map are necessary, then no new map is required, provided that the Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the above elements may suffice for a written report. Division records indicate the following permittee contact information. Please verify and make any necessary changes: Permittee Name: General Shale Brick, Inc. Div. c3o3� 783 - 30q/ (303 aqig, If you have additional comments and /or information that should be provided to the Division, please provide it below or attach it to this form along with your written report and map. Annual Report instructions are enclosed.