2002-12-23_REPORT - M1996064

• Permit No: M1996064
• IBM Index Class Name: Report
• Doc Date: 12/23/2002
• Doc Name: Annual Fee/Report Notice
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

ANNUAL FEE and REPORT REQUEST
RECEIVED
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
The Denver Brick Company
M-1996-064
Stevens Clay Lease
December 23, 2002
DEC 2 3 2002
Division of Minerals and Geology
$688.00 (Due on or before your anniversary date)
Douglas
According to C.R.S. 34-32.5-I 16 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- uring tfie 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 [he date active operations ceased for the year, if any.
Please attach your revised written annual report and annual report map to this form. 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 Contact: Fiatry-amines
11;1 ly~~ox
Permittee Name: The Denver Brick Company
Address: 401 Prairie Hawk Dr.
Castle Rock, CO 80104
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.
Signaturra~ff cer, Owner or Designee
/~-~~~
Date
M:~PERM ITMASTER DOCUMENTSN~i-AF-01