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a <br /> COLORADO JANp5 2917 <br /> Division of Reclamation, <br /> Mining and Safety <br /> Department of Natural Resources <br /> 1313 Sherman t. Room 215 <br /> Denver, CO 80 3 <br /> Northern Colorado Constructors,Inc.; <br /> January 2, 2017 <br /> Chris Zadel <br /> Northern Colorado Constructors,Inc.Aggregate Div <br /> 9075 WCR 10 <br /> Fort Lupton,CO 80621 <br /> NCCI Pit 91,Permit M-2001-107,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 <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 ("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-2001-107 <br /> Operation Name: NCCI Pit#1 <br /> Anniversary Date: February 27,2017 <br /> Total Fee Due: $791.00(Due on or before your Anniversary Date) <br /> owc l L'9-5-D&AaS9) !Z <br /> G ���Ar <br /> AW <br /> �" ` <br /> _. _ c.,► <br /> �w of 0- <br /> 1313 Sherman St. Room 215 Denver,CO 80203 P(303)866-3567 F <br /> t <br /> John W. Hickenlooper,Governor Robert W. Randall, Executive Director I Virginia Brannon, Director <br />