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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 /> January 29,2016 <br /> Mark Brown <br /> City of Holyoke <br /> 407 East Denver Street <br /> Holyoke,CO 80734 <br /> Arthur-Mae Gravel Pit,Permit M-2014-068,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(the <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$323.00 fee is due for the following: ©I" �` t <br /> Permit: M-2014-068 t✓�" <br /> Operation Name: Arthur-Mae Gravel Pit <br /> Anniversary Date: March 18,2016 <br /> Total Fee Due: $323.00(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 /> If you have additional comments and/or information that should be provided to the Division,please provide it below <br /> or attach it to this form along with your written report and map. Annual Report instructions are enclosed. If you have <br /> U"Coz, <br /> 1313 Sherman St. Room 215 Denver,CO 80203 P(303)866-3567 F <br /> John W. Hickenloo er,Governor I Mike King, Executive Director I Virginia Brannon,Director * ..� *' <br /> \�`1876 j <br />