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Page 2 of 5 <br /> Return the enclosed Anrval Report FQRM,a MAP,and a CHECK or M,QN_EY ORDER made payable to: <br /> Division of Reclamation, Mining and Safety, 1313 Sherman St, Room 215, Denver,CO 80203 If your <br /> records indicate these 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 <br /> it below or attach it to this form along,with your%vTitten report and map. Annual Report instructions are <br /> enclosed. If you have any questions, please feel free to contact Scottie Tate((303)866-3567 ext 8166), <br /> Michelle Ramirez((303)866-3567 exl 81 I4),oremait dnr dmuminadmin a state,co.us. Thant;you for your <br /> cooperation in this rnatter. <br /> IF THE ANN"!AL I'LE SUB4MIT"I`AL5 ARE NOT RECEIVED ON OR BEFORE YOi, R <br /> AN,'NIVERSARY DATE. THE EN-FO.RCLMEN1 PROCESS WILL AUTOMATICALLY B <br /> INITIATED ENroiRcEt'.tF:N'I AC=10,%,S NIA4' RESULT IN CIVIL PENALTIES AND OR <br /> REVOCATION OF YOUR Ill.RMIT <br />