2017-05-31_REPORT - M1977284

• Permit No: M1977284
• IBM Index Class Name: Report
• Doc Date: 5/31/2017
• Doc Name: Annual Fee/Report/Map
• From: Cotter Corporation
• To: DRMS
• Annual Report Year: 2017
• Email Name: DMC
• 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:
m=Sheri4mr-
_
RScott Pottorff•7
Permittee Company:
Cotter Corpora iion
Address:
P.O. Box 700
Nucla, CO 81424
Phone Number:
-(-R74964-7-34A -734 ,
970-773-4167
Fax Number:
-'
Email Address:
[e-mail]
Permitting Contact:
e'* v-•
Gus Gavi oti s
Company:
Cotter Corporation
Address:
-P-0. Bur, �66-
4
7800 E. Dorado Place Suite 210 �
Englewood, CO 80111-0700
Phone Number:
720-554-6211 v
Fax Number:
864
720-554-6201
Email Address:
4im.Sh"idan@eottmtsacum
[e-mail]
Inspection Contact:
Scott Pottorff
Company:
Cotter Corporation
Address:
P.O. Box 700
Nucla, CO 81424
Phone Number:
970-773-4167 !�
Fax Number:
Email Address:
Ma.uu
[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
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