2017-04-11_REPORT - M1977424 (2)

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COLORADO Division of Rectamation, AT Mining and Safety Drallmeml o! Na:aral Re=lres 1313 511ennarl Sc. "aan t ocnrer. Co Bii203 February 1, 2017 Mike Andersc-n Occidental On Shale, Inc C/o Glenn Springs Holdings, Inc 5005 Lyndon Q Johnson FWY Ste 1350 Dallas, TX 75244-6 1150 Logan Wash, Permit 111-1977-424, Annual Fee Invoice and Report Reques PLEASE RFAi) CARF,FULLY AC-11Oa1 REQUIRED l'le.iw attach your CC111P1.E;'FFD trrit(cn Annual Report ant! Annual ltclwrt Mot) to this form Under the terms of your Reclamation Permit and Colorado Statutes, you must submit an Annual Fee and Annual Repan (including a map). You must pay the Annual Fee and submit an Annual Report each year until reclamation responsibility release is granted. The Annual Fee is not a renewal fee. The Fee and Report are for LAST YEAR'S mining and reclamation season, and MUST be paid even if your operation was inactive The Annual Report and Fee requirement will be considerer! submitted %vhcn we have received the following components: 1. APPROPRIATE ANNUAL FEE 2. COMPLETED ANNUAL, REPORT 3. ASSOCIATED MAP as required by rule If you have requested reclamation responsibility release from the Division of Reclamation, Alining and Safety (the "Division") but your permit is not released by the anniversary date listed below, the Annual Fee MUST be paid. If the permit is released before the anniversary date, then by Statute, it is not necessary to pay an Annual Fee or submit an Annual Report for that year. Division records indicate the 5633.00 fee is due for the following: Permit: M-1477424 Operation Name: Logan Nash ✓ Anniversary Date: March 28, 2017 Total Fee Due: $633.00 (Due on or before your Anniversary Date) OT Co w� 1313 Shvmdn ;t Rpgm 215 Deriver CO 302(7) P (303) 666 3561 F ( +yt WX Jotv1 IN H :�enl7cper Ga�crnor 1 Rctcrt W Rancall. Exctut .c Oirector 1 Virginia Brannon Crrettcr ��'J