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� COLORADO <br /> '7��' <br /> Division of Reclamation, <br /> Mining and Safety <br /> t;, :rh, -,,_Of Pt3hirai P <br /> 1313 Sherman St. Room 215 <br /> Denver, CO 80203 <br /> May 1, 2015 <br /> John Dietzler <br /> Dietzler Construction Corporation <br /> 5027 CR 37 <br /> Yoder, "Y 82244 <br /> Pawnee Aggregate Pit,Permit M-2012-014,Annual Fee Invoice and Report Request <br /> PLEASE READ CAREFULLY—ACTION REQUIRED <br /> Please attach your COMPLETED written 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 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$791.00 fee is due for the following: <br /> Permit: M-2012-014 <br /> Operation Name: Pawnee Aggregate Pit <br /> Anniversary Date: June 20,2015 <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 /> 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 /> 1313 Sherman St. Room 215 Denver, CO 80203 P(303)866-3567 F <br /> John W. Hickenlooper, Governor I Robert W. Randall, Executive Director ( Virginia Brannon, Director <br /> 1876 <br />