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i <br /> <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />The Denver Brick Company <br />M-1996-064 <br />Stevens Clay Lease <br />December 23, 2004 <br />J D1 <br />~:.2.~..~~d ~ ~:.. <br />DEC 15 2C04 <br />tllvlolon of f5icarals & fdcc(cpy <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. 34-32-116, 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-and-during-the preceding year, new disturbances that are-anticipated to occur-- <br />during the upcoming year, reclamation that will be perfonned 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 vrnur revised written anneal rennrt and anmral report man to this form. Please note That an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Phil McCoy <br />Permittee Name: The Denver Brick Company <br />Address: 401 Prairie Hawk Dr. <br />Castle Rock, CO 80104 <br />Phone Number: (303) 688-6951 <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 t tht o. ;~ f~rnrajong with your written report and map. Annual Report instructions are enclosed. <br />Signature of Corporate Officer, Owner, or Designee <br />/Z_a~_ ay <br />Date <br />