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AVCOLORADO <br /> Division of Reclamation. <br /> Mining and Safety <br /> Department of Natural Resources <br /> 1313 Sherman St.Room 215 <br /> Denver,CO 80203 <br /> August 1,2016 <br /> Michael S.Davis <br /> Dolores County <br /> P.O.Box 608 <br /> Dove Creek,CO 81324 <br /> Bartley Gravel Pit,Permit M-1984-155,Annual Fee Invoice and Report Request <br /> PLEASF READ CAREFULLY—ACTION REQUIRED <br /> Please attach your COMPLETED kN ritten Annual Report and Annual Report Man to this form <br /> Under the terms of your Reclamation Permit and Colorado Statutes,you must submit an Annual Fee and <br /> Annual Report(including a map). You must pay the Annual Fee and submit an Annual Report each year <br /> until reclamation responsibility release is granted. The Annual Fee is not a renewal fee. The Fee and Report <br /> are for LAST YEAR'S mining and reclamation season, and MUST be paid even if your operation was <br /> inactive. <br /> The Annual Report and Fee requirement will be considered submitted when we have received the <br /> following 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 <br /> Safety(the"Division")but your permit is not released by the anniversary date listed below,the Annual Fee <br /> MUST be paid. If the permit is released before the anniversary date,then by Statute, it is not necessary to <br /> pay an Annual Fee or submit an Annual Report for that year. <br /> Division records indicate the$791.00 fee is due for the following: <br /> Permit: M-1984-155 <br /> Operation Name: Bartley Gravel Pit <br /> Anniversary Date: September 27,2016 <br /> Total Fee Due: $791.00(Due on or before your Anniversary Date) <br /> 1313 Sherman St. Room 215 Denver,CO 80203 P t303)866-3567 F V $1' <br /> John W. Hickenlooper, Governor Robert W. Randall, Executive Director I Virginia Brannon, Director *; <br /> *1876 <br />