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STATE OF COLORADO <br />1SION OF RECLAMATION, MINING AND SAFETY <br />M- 1980 -252 <br />Operation Name: <br />artment of Natural Resources <br />Anniversary Date: <br />April 1, 2013 <br />Sherman St., Room 215 <br />--� <br />COLORADO <br />rer, Colorado 80203 <br />e: (303) 866-3567 <br />'�� <br />, <br />��� ��_n <br />p 1 V I S I O N O F <br />AMATION <br />RE MINING <br />(:(303) 832 -8106 <br />2 -810 <br />C� <br />— &— <br />SAFETY <br />March 1, 2013 <br />John W. tiickenlooper <br />ti <br />Governor <br />Dave Kintz <br />Park County <br />r <br />Mike King <br />Executive Director <br />P.O. Box 147 <br />S <br />Fairplay, CO 80440 <br />1)1V1SlON <br />MIN) OFREC <br />Loretta E. Pineda <br />Director <br />NGAND AT! <br />SAFETY <br />Jefferson Flat Pit, Permit M- 1980 -252, 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 />1. APPROPRIATE ANNUAL FEE <br />2. COMPLETED ANNUAL REPORT <br />3. ASSOCIATED MAP as required by role <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 $791.00 fee is due for the following: <br />Permit: <br />M- 1980 -252 <br />Operation Name: <br />Jefferson Flat Pit <br />Anniversary Date: <br />April 1, 2013 <br />Total Fee Due: <br />$791.00 (Due on or before your Anniversary Date) <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 />IF THE ANNUAL FEE SUBMITTALS ARE NOT RECEIVED ON OR BEFORE YOUR ANNIVERSARY <br />DATE, THE ENFORCEMENT PROCESS WILL BE AUTOMATICALLY IMATIED. ENFORCMENT <br />ACTIONS MAY RESULT IN CIVIL PENALTIES ANWOR REVOCATION OF YOUR PERMIT. <br />Office of Office of <br />Mined Land Reclamation Denver - Grand Junction - Durango Active and Inactive Mines <br />