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DIVISION OF RECLAMATION, MINING AND SAFETY <br />Department of Natural Resources <br />1313 Sherman St., Room 215 <br />Denver, Colorado 80203 <br />Phone: (303) 866 -3567 <br />FAX: (303) 832 -8106 <br />October 1, 2012 <br />Robert O. Ray <br />Lafarge West, Inc. <br />10170 Church Ranch Way, Ste. 200 <br />Westminster, CO 80021 <br />Chambers Pit, Permit M- 1980 -136, Annual Fee Invoice and Report Request <br />Division records indicate the $791.00 fee is due for the following: <br />Permit: M -1980 -136 <br />Operation Name: Chambers Pit <br />Anniversary Date: November 15, 2012 <br />Total Fee Due: $791.00 (Due on or before your Anniversary Date) <br />Mined Land Reclamation <br />1. APPROPRIATE ANNUAL FEE <br />2. COMPLETED ANNUAL REPORT <br />3. ASSOCIATED MAP as required by rule <br />STATE OF COLORADO <br />Under the terms of your NOI or Reclamation Permit and Colorado Statutes, you must submit Annual Fees and <br />Annual Reports (including a map). You must pay the Annual Fee and submit an Annual Report each year until <br />reclamation responsibility release is granted. The Annual Fee is not a renewal fee. The Fee and Report are for <br />LAST YEAR'S mining and reclamation season, and MUST be paid even if your operation was inactive. <br />11 11 1 ANNFIAI F1.1' WWII I ALS ARt NO1 Rh(4F.IV1 -.1) ON OK 131.1 OR1 1'UUR ANNIVL -RSARY <br />DA 1 l . f1111 I NI OR('I,MI.N'I I'ROCESS Wll 1 All I ONIA1 I(' \I I 1 1i1' IN'IA I Ill) ENFOR('FiMFN <br />A('I IONS N1AY RLStI1 1 IN ('IVI1 PENALTIES ANE) /OR I:I'VO( •1 PION Ol '0)tJR PF?RMIT <br />COLORADO <br />D I V I S I O N O F <br />RECLAMATION <br />MINING <br />— &— <br />SAFETY <br />John W. Hickenlooper <br />Governor <br />Mike King <br />Executive Director <br />Loretta E Pineda <br />Director <br />11,FAS1 11i,Ai) (' \iat ill l.l 0( II( 1N ilLQt!IRl <br />Please attach Now (_ (1i1P1.1 TLI) Repo! t tln(1 Annual Report I\lap to il►is fol ►u <br />The Annual Report and Fee requirement will be considered submitted when we have received the following <br />components: <br />If you have requested reclamation responsibility release from the Division of Reclamation, Mining and Safety <br />( "Division ") but your permit is not released by the anniversary date listed below, the Annual Fee MUST be paid. If <br />the permit is released before the anniversary date, then by Statute, it is not necessary to pay an Annual Fee or submit <br />an Annual Report for that year. <br />Return the enclosed Annual Report FORM, a MAP, and a CHECK or MONEY ORDER made payable to: Division <br />of Reclamation, Mining and Safety, 1313 Sherman St., Room 215, Denver, CO 80203. If your records indicate <br />these documents and fees have already been submitted, please notify the Division. <br />If you have additional comments and /or information that should be provided to the Division, please provide it below <br />or attach it to this form along with your written report and map. Annual Report instructions are enclosed. If you <br />have any questions, please feel free to contact Jim Dupler (303)866 -3567 x8119 or Christine Brookshire (303)866- <br />3567 x8132. Thank you for your cooperation in this matter. <br />Office of Office of <br />Denver • Grand Junction • Durango Active and Inactive Mines <br />