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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />- iii iiiiiiiiiiiiiiii <br />ANNUAL FEE and REPORT REQUEST <br />RECEIVED <br />The Denver Brick Company SEC ~ 8 2001 <br />M-1996.064 <br />Stevens Clay Lease pivision of Minerals and Geology <br />December 23, 2001 <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-] 16, each year, on the anniversary date of [he permit, an operator <br />shall submit [he 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 man to this form. Please mote that an <br />adequately labeled map that clearly delineates artd 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 />P <br />i <br />C ~JU <br />S CTaY"V V 111E5 <br />erm <br />ttee <br />ontact: a3ng <br />P <br />Permittee Name: The Denver Brick Company <br />Address: 401 Prairie Hawk Dr. <br /> Castle Rock, CO 80104 <br />Phone Number: (303) 688-6951 P~CI". ~.3~ <br />Fax Number: (303) 688-5270 <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 />Si re of rporate Officer or Owner <br />Date <br />M ~PERMnN1ASTERD000MEm'SU7~AF~01 <br />