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ICOLORADO <br /> AU I <br /> 1 Division of Reclamation, <br /> Mining and Safety <br /> 1313 Sherman St. Room 215 <br /> Denver, CO 80203 <br /> January 2, 2017 <br /> Thomas J. Murray <br /> The Lakewood Brick and Tile Company <br /> 1325 Jay St <br /> Lakewood,CO 80214-2052 <br /> Church Pit,Permit M-1979-045,Annual Fee Invoice and Report Request <br /> PLEASE READ CARL'Ft;LLY — :kC ION REEL iRED <br /> Please attach your COMPLETED�sritten ,\nnual Report and Annual Report .Ntap 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-1979-045 <br /> Operation Name: Church Pit <br /> Anniversary Date: February 28, 2017 <br /> Total Fee Due: $791.00(Due on or before your Anniversary Date) <br /> Col, <br /> -Ile J <br /> 1313 Sherman St. Room 215 Denver, CO 80203 P 003)866-3567 F <br /> Jahn W. Hrckentooper, Governor I Robert W. Randalt, Executive Director ! Virginia Brannon, Director �. I ,* <br />