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t171 <br /> 1E V� <br /> COLORADO JAN 04 2012 <br /> Fyn r Division of Reclamation, <br /> was€ Mining and Safety <br /> BY. <br /> Department of Natural Resources <br /> 1313 Sherman St.Room 215 711 }AAA I l— <br /> Denver,CO 80203 <br /> r <br /> January 2,2017 �D f� <br /> C.tcc 7o0,*sz 0 <br /> Kane Schneider <br /> Colorado Department of Transportation <br /> 606 S.9th St. <br /> Grand Junction,CO 81501 <br /> Dotsero Cinder Pit,Permit M-1979-155,Annual Fee Invoice and Report Request <br /> PLEASE READ CAREFULLY—ACTION REQUIRED <br /> Please attach vour COMPLETED written Annual Report and Annual Report Mal) 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 reauired 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$323.00 fee is due for the following: <br /> Permit: M-1979-155 <br /> Operation Name: Dotsero Cinder Pit <br /> Anniversary Date: February 1,2017 <br /> Total Fee Due: $323.00(Due on or before your Anniversary Date) <br /> I hereby c artify that I have received the goods or services listed <br /> harem. th,' I have carefully inspected weighed,counted or <br /> nteacztswd tha;commodities and found them in good condition <br /> and .,omptying with the specifications given or that the goods <br /> and sc Nv.aE are in Con.,riaC Compliance,or that the services <br /> were s:+thoal tgry except uti nobite t�rr. <br /> 0131.101ety 3ignitu!s of <br /> �r�ggods/services C �y7rt -� a� <br /> �`2� <br /> FGrol# r=rint Name of Cpl <br /> Cost Cartier C) 10 <br /> bJ. _ �ub. Function r� <br /> 1313 Sherman St.Room 215 Denver,CO 80203 P(303)866-3567 F I*• • <br /> John W.Hickenlooper,Governor ► Robert W.Randall,Executive Director I Virginia Brannon, Director /�% <br />