REP20252

• Permit No: M1977251
• IBM Index Class Name: Report
• Doc Date: 3/3/2004
• Doc Name: 2004 Annual Report
• From: Robinson Brick Company
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

RECEIVED
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Robinson Brick Company
M-1977-251
Lariat Pit
March 5, 2004
$688.00 (Due on or before your anniversary date)
Jefferson
MAR 0 3 2004
Division of Minerals & Geology
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 far the~reginning - -
of active operations, and the date active operations ceased for the year, if any.
Pl ash a attach yonr revised written annual report and annnal report main to this form. Please note that an
adequately labeled map that clearly delineates and includes the above elements may suff ce for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Marvin R. Myers, Jr.
Permittee Name: Robinson Brick Company
Address: 1845 W. Dartmouth Ave.
Denver, CO 80110-1308
Phone Number: [phone]
Fax Number: [phone]
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.
Signature of Corporate Officer, Owner, or Designee
Date