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COLORADO <br />Division of Reclamation, <br />Mining and Safety <br />Department of Natural Resources <br />1313 Sherman St. Room 215 <br />Denver, CO 80203 <br />November 2, 2015 <br />Jack Clark Jr <br />Jack Clark, Jr. <br />P. O. Box 767 <br />Silverton, CO 81433 <br />Upper Animas Sand and Gravel Pit, Permit M-2005-065, Annual Fee Invoice and Report Request <br />PLEASE READ CAREFULLY — ACTION REQUIRED <br />Please attach your COMPLETED written Annual Report and Annual Report Map to this form <br />Under the terms of your Reclamation Permit and Colorado Statutes, you must submit an Annual Fee and Annual <br />Report (including a map). You must pay the Annual Fee and submit an Annual Report each year until reclamation <br />responsibility release is granted. The Annual Fee is not a renewal fee. The Fee and Report are for LAST YEAR'S <br />mining and reclamation season, and MUST be paid even if your operation was inactive. <br />The Annual Report and Fee requirement will be considered submitted when we have received the following <br />components: <br />1. APPROPRIATE ANNUAL FEE <br />2. COMPLETED ANNUAL REPORT <br />3. ASSOCIATED MAP as required by rule <br />If you have requested reclamation responsibility release from the Division of Reclamation, Mining and Safety <br />("Division") but your permit is not released by the anniversary date listed below, the Annual Fee MUST be paid. If <br />the permit is released before the anniversary date, then by Statute, it is not necessary to pay an Annual Fee or submit <br />an Annual Report for that year. <br />Division records indicate the $791.00 fee is due for the following: <br />Permit: M-2005-065 <br />Operation Name: Upper Animas Sand and Gravel Pit <br />Anniversary Date: December 8, 2015 <br />Total Fee Due: $791.00 (Due on or before your Anniversary Date) <br />Return the enclosed Annual Report FORM, a MAP, and a CHECK or MONEY ORDER made payable to: Division <br />of Reclamation, Mining and Safety, 1313 Sherman St., Room 215, Denver, CO 80203. If your records indicate these <br />documents and fees have already been submitted, please notify the Division. <br />1313 Sherman St. Room 215 Denver, CO 80203 P (303) 866-3567 F <br />John W. Hickentooper, Governor I Mike King, Executive Director I Virginia Brannon, Director <br />