2016-02-18_REPORT - M1985170 (4)

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COLORADO I hereby cem(v that I have received the goods or services listed hereon, that ( have carefully insppeected, weighed, counted or measured the commodities and found the ood condition Division of Reclamation, and complying with the specig tions n w at the goods • and services are m contract M",, , w rvicea .. Mitring and Safety were satisfactory except as n Department of, Natutal Resources ate as Sig fu P goodslser�q"ces 1313 Sherman St. Room 215 $� Denver, CO 80203 EC;F—IVF `C aVol # — Print me As /— N — — December 31, 2015 V L ost Center Obj. — / Sub. Function FEB 0 8 2016 Kane Schneider Colorado Department of Transportation 606 S. 9th St. \i rL- 7avo 241 7,z2 Grand Junction, CO 81501 2�) (0\ /� V g A I 49,q Q& 3 e/ plJ �/7 BLM Burnt Shale Pit, Permit M-1985-170, Annual Fee Invoice and Report Request PLEASE READ CAREFULLY — ACTION REQUIRED Please attach vour 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 $323.00 fee is due for the following: Permit: M-1985-170 Operation Name: BLM Burnt Shale Pit Anniversary Date: February 1, 2016 Total Fee Due: $323.00 (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 have �o4.cc 1313 Sherman St. Room 215 Denver, CO 80203 P (303) 8663567 F 4a -y o John W. Hickentooper, Govemor I Mike King, Executive Director I Virginia Brannon, Director Ia*`azsw* X876