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~y <br />PERMTI'TEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />~ The Denver Brick Company <br />,/M-1997-007 <br />Bijou Clay Mine <br />February 19,2007 <br />/~2 <br />~~-~z-~7 <br />y~~l~:,~ <br />/ FF9 <br />~i~iSip <br />M%ni~9a dsai alff n. <br />$$688.00 (Due on or before your anniversary date) ty <br />Elbert <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 an8-during'the-precedingyear,-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, resort, and associated <br />map. If no new disturbances or reclamation have occurred durinc the arevious vear and no new chances 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 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 C. Templeton <br />Permi[tee Name: The Denver $rick Company <br />Address: 401 Prairie Hawk Dr. <br />Castle Rock, CO 80104 <br />and/or information that should be provided to the Division, please provide it <br />with your written report and map. Annual Report instructions are enclosed. <br />or Designee <br />Phone Number: (303) 688-6951 <br />Fax Number: (303) 688-9894 <br />If you have additional <br />bel~ attach it to thi <br />i <br />,~ / <br />~' ~ ~ <br />Signature o Corporate <br />Z ~ Q ` ti <br />Date <br />