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, <br /> A DNR COLORADO <br /> f <br /> CO g Division of Reclamation, <br /> Mining and Safety <br /> Department of Natural Resources <br /> 1313 Sherman St. Room 215 <br /> Denver, CO 80203 <br /> April 1,2016 <br /> Mary Kauffman 'Y 1 <br /> Jake Kauffman&Son,Inc. <br /> 808 SCR 9E J .X <br /> Loveland,CO 80537 <br /> Kauffman Pit,Permit M-1978-327,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-1978-327 <br /> Operation Name: Kauffman Pit <br /> Anniversary Date: May 14,2016 <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 /> C7'oF0 CDS <br /> 1313 Sherman St. Room 215 Denver, CO 80203 P (303)866-3567 F ( loIi <br /> John W. Hickenlooper, Governor I Robert W. Randall, Executive Director I Virginia Brannon, Director � \;;, */ <br /> \/87ej <br />