2015-07-20_REPORT - M1981086 ‎(3)‎

• Permit No: M1981086
• IBM Index Class Name: REPORT
• Doc Date: 7/20/2015
• From: N Colo Water Conservancy Dist.
• To: DRMS
• Annual Report Year: 2015
• Permit Index Doc Type: Annual Fee/Report
• Email Name: PSH
• Media Type: D
• Archive: No

IMM- COLORADO
1*0 kv Division of Reclamation,
M MV Mining and Safety
Department of Natural Resources
1313 Sherman St. Room 215
Denver, C080203
June 1, 2015
JimStruble
N Colo Water Conservancy Dist.
220 Water Avenue
Berthoud, C080513
RECEIVED/SCANNED
NCWCD
JUN - 4 2015
1 7%17
ORIGINAL. FILE COPY
Borrow Area C, Permit M-1981-086, Annual Fee Invoice and Report Request
PLEASE READ CAREFULLY — ACTION REQUIRED
Please attach your COMPLETED written Annual Report and Annual Report Map to this form
Under the terms of your Reclamation Permit and Colorado Statutes, you must submit an Annual Fee and Annual
Report (including a map). You must pay the Annual Fee and submit an Annual Report each year until reclamation
responsibility release is granted. The Annual Fee is not a renewal fee. The Fee and Report are for LAST YEAR'S
mining and reclamation season, and MUST be paid even if your operation was inactive.
The Annual Report and Fee requirement will be considered submitted when we have received the following
components:
1. APPROPRIATE ANNUAL FEE
2. COMPLETED ANNUAL REPORT
3. ASSOCIATED MAP as required by rule
If you have requested reclamation responsibility release from the Division of Reclamation, Mining and Safety (the
"Division") but your permit is not released by the anniversary date listed below, the Annual Fee MUST be paid. If
the permit is released before the anniversary date, then by Statute, it is not necessary to pay an Annual Fee or submit
an Annual Report for that year.
Division records indicate the $791.00 fee is due for the following:
Permit:
M-1981-086
Operation Name:
Borrow Area C
Anniversary Date:
July 21, 2015
Total Fee Due:
$791.00 (Due on or before your Anniversary Date)
Return the enclosed Annual Report FORM, a MAP, and a CHECK or MONEY ORDER made payable to: Division
of Reclamation, Mining and Safety, 1313 Sherman St., Room 215,. Denver, CO 80203. If your records indicate
these documents and fees have already been submitted, please notify the Division.
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. If you
1313 Sherman St. Room 215 Denver, CO 80203 P [phone] F
John W. Hickentooper, Governor IMike King, Executive Director I Virginia Brannon, Director