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COLORADO <br />D I V I S I O N O F <br />RECLAMATION <br />MINING <br />—&- <br />- SAFETY <br />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 />December 3, 2012 <br />Dale Kortz <br />Forest Lakes Metro District <br />P.O. Box 440 <br />Bayfield, CO 81122 -0440 <br />Forest Lakes Pit #1, Permit M- 1981 -158, 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 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 />Office of <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 />Pierq <br />4) <br />r <br />If you have requested reclamation responsibility release from the Division of Reclamation, Mining and Safety (the <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 />Division records indicate the $323.00 fee is due for the following: <br />Permit: M- 1981 -158 <br />Operation Name: Fore Pit #1 <br />Anniversary Date: anuary 26, 2 13 <br />Total Fee Due: $323.01 s s e on or before your Anniversary Date) <br />Return the enclosed Annual Report FORM. a MAP, and a CHECK or MONEY ORDE payable to: Division <br />of Reclamation, Mining and Safety, 1313 Sherman St., Room 215, Denver, CO 80203 tr 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 Div' ase provide it below <br />or attach it to this form along with your written report and map. Annual Report instructio enclosed. If you <br />have any questions, please feel free to contact Jim Dupler (303)866 -3567 x8119 or Christi `., + �kshire (303)866- <br />3567 x8132. Thank you for your cooperation in this matter. <br />IF THE ANNUAL FEE SUBMITTALS ARE NOT RECEIVED ON OR BEFORE YOLJIVERSARY <br />DATE, THE ENFORCEMENT PROCESS WILL BE AUTOMATICALLY INIATIED. RCMENT <br />ACTIONS MAY RESULT IN CIVIL PENALTIES AND /OR REVOCATION OF YOUR PERMIT. <br />John W. Hickenlooper <br />Govemor <br />Mike King <br />Executive Director <br />Loretta E. Pineda <br />Director <br />Office of <br />Denver • Grand Junction • Durango Active and Inactive Mines <br />