2001-09-24_REPORT - M1977300

• Permit No: M1977300
• IBM Index Class Name: Report
• Doc Date: 9/24/2001
• Doc Name: Annual Fee/Report Notice
• Permit Index Doc Type: ANNUAL FEE / REPORT
• Media Type: D
• Archive: No

- ` � . III IIIIIIIIIIIIII
999 11
ANNUAL FEE and REPORT REQUEST
PERMTTTEE NAME: Cotter Corporation
PERMIT NO.: M-1977-300 RECOEIV ED
OPERATION NAME: Schwartzwalder Z 4 200�
Sf:P
ANNIVERSARY DATE: September 28,2001
°t tJllnera
ANNUAL FEE DUE: $550.00(Due on or before your anniversary&W)'p° a°d Ge°t0 t
COUNTY: Jefferson
According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary daft: of the permit, an
operator shall submit the annual fee, a report and map showing the extent of current distw,-bances to affected
land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to
occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the
beginning of active operations, and the date active operations ceased for the year, if any.
Please attach your revised written annual report and annual report map to this form. Please note that an
adequately labeled map that clearly delineates and includes the above elements may safce for a written
report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Timothy Pierce
Permittee Name: Cotter Corporation
Address: P.O. Box 1017
Golden,CO 80402
Phone Number: [phone]
Fax Number: [phone]
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are
enclosed.
Signature of Corpor e Officer or Owner
9 /p a
Date
MdPERMINIASTERDOCUMENTSR4-AF-02 DOC