2015-10-01_REPORT - M2003001 (3)

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A71 Division of Reclamation, Mining and Safety i C:epaflrtemt of Natv!� ,l R�,sourc.-s 1313 Sherman St. Room 215 Denver, CO 80203 October 1, 2015 Mark Johnson Bestway Concrete Company 301 Centennial Dr. Milliken, CO 80543 RECEIVED OCT 19 ZO15 MVM?i OF RKLAMMM r Nissen Farm Resource, Permit M-2003-001, Annual Fee Invoice and Report Request PLEASE READ CAREFULLY- ACTION REQUIRED Please attach vour COMPLETED -vvritten Annual Report and Annual Report Map to this form Under the terms of your Reclamation Permit and Colorado Statutes, you must submit an Annual Fee and Annual Report (including a map). You must pay the Annual Fee and submit an Annual Report each year until reclamation responsibility release is granted. The Annual Fee is not a renewal fee. The Fee and Report are for LAST YEAR'S mining and reclamation season, and MUST be paid even if your operation was inactive. The Annual Report and Fee requirement will be considered submitted when we have received the following components: 1. APPROPRIATE ANNUAL FEE 2. COMPLETED ANNUAL REPORT 3. ASSOCIATED MAP as required by rule If you have requested reclamation responsibility release from the Division of Reclamation, Mining and Safety ("Division") but your permit is not released by the anniversary date listed below, the Annual Fee MUST be paid. If the permit is released before the anniversary date, then by Statute, it is not necessary to pay an Annual Fee or submit an Annual Report for that year. Division records indicate the $791.00 fee is due for the following: Permit: M-2003-001 Operation Name: Nissen Farm Resource Anniversary Date: November 21, 2015 Total Fee Due: $791.00 (Due on or before your Anniversary Date) Return the enclosed Annual Report FORM, a MAP, and a CHECK or MONEY ORDER made payable to: Division of Reclamation, Mining and Safety, 1313 Sherman St., Room 215, Denver, CO 80203. If your records indicate these documents and fees have already been submitted, please notify the Division. 1313 Sherman St. Room 215 Denver, CO 80203 P (303) 866-3567 F John W. Hickentooper, Governor I Mike King, Executive Director ) Virginia Brannon, Director