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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 />Goldman Gravel Pit, Permit M- 1978 -279, Annual Fee Invoice and Report Request <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 />The Annual Report and Fee requirement will be considered submitted when we have received the following <br />components: <br />Mined Land Reclamation <br />Fred Frei <br />Flag Resources Inc <br />1412 CR 311 <br />New Castle, CO 81641 <br />I)( - \k11 (11,1.1' ('I l()Nltl,(}(Jlkrl) <br />Plcase attach \ our ('()1111`l,b;'I'i?I) NV I'111elt Annual Report :snd Anllual Itelrot t fVh p to this forth <br />1. APPROPRIATE ANNUAL FEE <br />2. COMPLETED ANNUAL REPORT <br />3. ASSOCIATED MAP as required by rule <br />Division records indicate the $323.00 fee is due for the following: <br />Permit: M -1978 -279 <br />Operation Name: Goldman Gravel Pit <br />Anniversary Date: November 22, 2012 <br />Total Fee Due: $323.00 (Due on or before your Anniversary Date) <br />STATE OF COLORADO <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 />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 />II. 1 HF ANNUM 1 EL SUBMI l I'AI S ARE NO I RECEIVED ON OR liEI ORI YOUR ANNIVERSARY <br />DA11. EHE I NLOR('EMENI PROCESS \ \'ll I A(IIO \1\'IICALI Y NI INIAll1 -:f) ENEOR("FMEN <br />AC'TION'S MAY RFS[JI,1 IN ('IVII PFNAI '111.5 AND/OR R1 \'OEA 1lON OF YOI IR PFIZM11 <br />Office of Office of <br />Denver • Grand Junction • Durango Active and Inactive Mines <br />