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• COLORADO Division of Reclamation, a Mining and Safety Department of Natural Resources 1313 Sherman St. Room 215 Denver, CO 80203 May 1,2017 Rick Barth City of Rifle 202 Railroad Avenue Rifle,CO 81650 City of Rifle Material Resource Area,Permit M-2007-030,Annual Fee Invoice and Report Request PLEASE READ CAREFULLY—ACTION REQUIRED Please attach your COMPLETED written Annual Report and Annual Report Map to this form Under the terms of your Reclamation Permit and Colorado Statutes, you must submit an Annual Fee and Annual Report(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 considered submitted when 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, Mining 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 $323.00 fee is due for the following: Permit: M-2007-030 Operation Name: City of Rifle Material Resource Area Anniversary Date: June 13,2017 Total Fee Due: $323.00(Due on or before your Anniversary Date) OF co 1313 Sherman St. Room 215 Denver, CO 80203 P (303)866-3567 F tyeGi r John W. Hickenlooper,Governor Robert W. Randall, Executive Director Virginia Brannon, Director 1876*