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COLORADO <br />Division of Reclamation, <br />Mining and Safety <br />Departmem of Natural Resources <br />1313 Sherman St. Room 215 <br />Denver, CO $0203 <br />September 1, 2016 <br />Kevin Dodson <br />Pinneo Feedlot, LTD. Liability Company <br />32295 Hwy 34 <br />P.O. Box 384 <br />Brush, CO 80723 <br />Headley, Permit M-1980-135, 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-1980-135 <br />Operation Name: Headley <br />Anniversary Date: October 7, 2016 <br />Total Fee Due: $791.00 (Due on or before your Anniversary Date) <br />a4 C0 <br />�' � <br />11r�' <br />c <br />1313 Sherman St. Room 215 Denver, CO $0203 P (303)866-3567 F "^I�' <br />John W. Hickentooper, Governor t Robert W. Ranrlalt, Executive Director f Virginia Brannon, Director ►, **' <br />,� 1876 , <br />