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Pagel aT5 <br />Return ft enclosed Annual RMrt_FORM, a MAP, and a CHECK or MONEY ORDER made payable <br />Division of Reclamation, Mining and Safety, 1313 Sherman St., Room 213, Deaver, CO SM. if your <br />recardsindicateificse documents andfeesime aSrea itybeen sdbmitte6,pieaszwoff <br />1be1VwmznL <br />If you have additional comments and/or information that should be provided to the Division, please provide <br />h bel6Wor-attach-k to -this form along with your written 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 ext 8114), or email dnr_drmsminadmin;a.state.co.us. Thank you for your <br />cooperation in this matter. <br />IF THE ANNUAL FEE SUBMITTALS ARE NOT RECEIVED ON OR BEFORE YOUR <br />ANNIVERSARY DATE, THE ENFORCEMENT PROCESS WILL BE AUTOMATICALLY <br />INITIATED. ENFORCEMENT ACTIONS MAY RESULT IN CIVIL PENALTIES AND.OR <br />REVOCATION OF YOUR PERMIT. <br />