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COLORADO Division of Reclamation, Mining and Safety Department of Natural Resources RECEIVED 1313 Sherman St. Room 215 Denver, CO 80203 JUL 21 2016 May 31, 2016 DIVISION OF RECLAMATION MINING AND SAFETY Peter L. Dawson Baca County 741 Main St.,Suite 1 Springfield,CO 81073 Bulkley Pit No 17,Permit M-1981-138,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-1981-138 Operation Name: Bulkley Pit No 17 Anniversary Date: July 24,2016 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 Q .0V CpI0 9 1313 Sherman St. Room 215 Denver-, CO 80203 P (303) 866-3567 F' I `� o' John W. Hickentooper, Governor Robert W. Randall, Executive Director I Virginia Brannon, Director ,,., r* *i876�