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Shp <br />RECEIVED <br />DEC 2 22005 <br />Oiwuua at 14¢enls.,a ce.l.~r <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, 2005 <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. 34-32-11 b, each year, on the anniversary date of the permit, an operator <br />sitali subs~iit-'i'er~snuei-2'ee, a'repSrt~rrd-map showing-the e~e6f current d~srurbances fo 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 vrm~r revised written anneal rennrt and anneal rennrt m~ to this form- Please note that att <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: Albert Templeton <br />Permittee Name: T"° r'°-°°- ° '~U r <br />Address: 401 Prairie Hawk Dr. <br />Castle Rock, CO -S9i~'4 <br />Phone Number: (303) 688-6951 <br />Fax Number: (393}688=5270' <br />,~w~e ~r t~c C.B ~ n'~ <br />&ol n 5 <br />303- 6&-Fr- 9rs9y <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />be]ow or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />~ ~/l <br />~/ <br />Signature o Corporate Offi Owner, or Designee <br />Date <br />