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99/95/2995 22:19 3935427379 COTTER CORPORATION PAGE 93 '~ <br />-- ~ ~ y z~- osr <br />~~g~P~ t <br />r-a r ~ ~G <br />AN Nf(Af. FFF and RF.P(1RT RFlltiF.ST <br />PERM]TTEL NAME: Cotter Corporation <br />PERMIT NO.: Yid-1977-300 <br />UPERA'I'ION NAME: Schwartzwalder <br />ANNIVERSARY DAI'L': September 28, 2005 <br />ANNUAL. FF.F. DUE: $550.00 (Due nn or before your anniversary date) <br />C:UUNTY: Jefferson <br />According to C.R.S. 34-32,5-116 yr C'. R.S. 34-32-116, each year, on the anni~•crsary date of the permit, an <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br />land, reclamation accomplished to date and during the preceding year, new dtsturbances that are anticipated to <br />occur during the upcoming year, reclamation that .viii be performed during the coming year, the dates for the <br />beginning of active operations; and the date active operations ceased for the year, if any. <br />Please attach ym~r revised written annnnl report and annual re nrt map to this form. please note [hat an <br />arleyua[e!y luheled map that clearly definea(es' artd inc(ude.> the above elements may since for a written <br />report. <br />Division recvrd9 indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittec Contact: Timothy Pierce <br />Pcrmittee Name: Cotter Corporation <br />Address: 1'.O. Box 10 i 7 <br />Golden, CO fi0402 <br />Phone Number: (3U3) 642-3893 <br />Fax Number: (303) 642-7379 <br />[f you have additional comments andinr information that should be provided to the Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report mstructiotts arc <br />enclosed. <br />Signature of Corpo to Officer, Owner, or Designer <br />p~ ~ O r <br />Dat -~ <br />MFl'F;RM I T~MASrER IXJCUM1iFNTS,'M-AF-Od. DOC <br />