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<br />~~~~~~~~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />Robinson Brick Company <br />M-1977-326 <br />Siloam Mine <br />November 23, 2003 <br />$225.00 (Due on or before your anniversary date) <br />Pueblo <br />NOV 0 4 200 <br />Division of Minerals and Geology <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 <br />--operator-shall-submit-the annual-fee,-a-report and-map-showing-the-extent-of-current-disturbances-to-affected -- - <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach ~r revised written annnal rennrt and anmral re~nrt m P to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Michael G. Leidich <br />Permittee Name: Robinson Brick Company <br />Address: 1845 W. Dartmouth Ave. <br />Englewood, CO 80110 <br />_P_hone-Number: (303) 783-3047- - -w_j-3-~t `~-~,.-z3~y/.7-- - - - - <br />I <br />Fax Number: , 3p~7~3 •-~2 <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 <br />enclosed. <br />Signature of Corporate Officer, Owner, or Designee <br />Date <br />M:~PER MITMASTERDO W M ENTS/M-AF-W. DOC <br />