2017-04-28_REPORT - M1977284

• Permit No: M1977284
• IBM Index Class Name: Report
• Doc Date: 4/28/2017
• Doc Name: Annual Fee Notice
• From: DRMS
• To: Cotter Corporation
• Annual Report Year: 2017
• Media Type: D
• Archive: No

Page 5 of 5

Division records indicate the following permittee/landowner contact information (blank fields indicate that we do not have
information on record). If this information is blank or not current , please type or print current contact information:

Permittee Contact:

Jim Sheridan
Permittee Company:

Cotter Corporation
Address:

P.O. Box 700
Nucla, CO 81424

Phone Number:

[phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact:

Jim Sheridan
Company:

Cotter Corporation
Address:

P.O. Box 700
Nucla, CO 81424

Phone Number:

[phone]
Fax Number: [phone]
Email Address: [e-mail]
Inspection Contact:

Jim Sheridan
Company:

Cotter Corporation
Address:

P.O. Box 700
Nucla, CO 81424

Phone Number:

[phone]
Fax Number:
Email Address: [e-mail]

I, the undersigned, hereby state that the information provided in this report is true and accurate, and that site operations are
being conducted in accordance with the Division approved mining and reclamation plans.

Signature of Permittee, Corporate Officer, Owner, or Documented Designee Date
M-AF-02