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COLORADO <br /> Division of Reclamation, <br /> Mining and Safety <br /> 1313 Sherman St. Room 215 <br /> Denver, CO 80203 <br /> August 1, 2017 <br /> Thomas J. Murray <br /> The Lakewood Brick and Tile Company <br /> 1325 Jay St <br /> Lakewood,CO 80214 <br /> Doughty's Pit,Permit M-1975-009,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 terns 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 ruining 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 S323.00 fee is due for the following: <br /> Pen-nit: M-1975-009 <br /> Operation Name: Doughty's Pit <br /> Anniversary Date: September 30,2017 <br /> Total Fee Due: $323.00(Due on or before your Anniversary Date) <br /> 1313 Sherman St. Room 215 Denver. CO 80203 P 003)866-3567 F <br /> John W Hrckenlooper. Governor I Robert W. Randall, Executive Director t Virginia Brannon, Director <br />