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hhp <br />RECEIVED <br />DEC222~ <br />Oivisioa of eemuals aaa fieMr~ <br />PERMITTEE NAME: <br />PERMTI' NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />The Denver Brick Company <br />M-1996-064 <br />Stevens Clay Lease <br />December 23, 2005 <br />$688.00 (Due on or before your anniversary date) <br />Douglas <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-I 16, each year, on the anniversary date of the permit, an operator <br />- -shall ;`tibtnitihe a~ur'ttal-fee; aJrepuzt-anti-map shciwing'the erdent'of ourrent disrurbances to affecied land; <br />reclamation accomplished to date and during the preceding year, new disturbances that aze anticipated to occur <br />during the upcoming yeaz, 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 ynnr revised written anmial report and anneal report martn this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Albert Templeton <br />Permittee Name: Tn° r'°°^°" u^^U r' <br />Address: 401 Prairie Hawk Dr. <br />Castle Rock, CO ~0~1'0'4 <br />Phone Number: (303) 688-6951 <br />Fax Number: (~03j-tt88=3270' <br />~r H, e l~r t~c ~6:-wnps, L <br />~'sO1O5 <br />303- 6 fr-~- 3&9~/ <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 instrucfions are enclosed. <br />Signature of Corporate <br />or Designee <br />l~ /ab /bs <br />Date <br />