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19/25/2994 19:24 9799547297 COTTER CORP NUCLA <br />1 <br />ANNTiAY. FFF. And RF,PfIRT RF(~i1F.ST <br />PERMTfTEL NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUA7.. FEE DUE: <br />COUNTY: <br />Cotter Corporation <br />M-1978-286-I~Ii <br />Liberty Mlne <br />November 1, 2004 <br />PAGE 93/94 <br />~~ <br />~ ~~,. ~ ~ ?coa <br />- . n' <br />7i"i=:. <br />$225.00 (Due an or before your anniversary date) <br />Mesa <br />According to C.R.S. 34-32.5-]16 or C.R.S. 34-32-116, each year, on the anniversary date of the pemtit, an <br />operator shay) 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 disturbances that are anticipated to <br />occur during the upcoming yeaz, reclamation that will 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 a tack ymrr revicrd wrlt[en anneal r nnrt And Anneal re ni,(L f ttla~ to thic form Please note that an <br />adequately laheled wrap tfrat clearly delin¢ater wrd includes the above elements may since for a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittec Contact: Glen Williams <br />Permittee Name: Cotter Corporation <br />Address: P.O. Box 700 <br />Nucla, CO 81424 <br />Fhone Number: (970) 864-7347 <br />Fax Number: (970) 864-7287 <br />If you have additional comments and/or inforrnation 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 instructions are <br />enclosed. <br /> <br />Signature of Corpora')f/Officer, Owner, or Desigtee <br />/D /d s /~ ~ <br />pare <br />M.fPBRMInhfASTF.tUX~C[IMEKfS~.r-AF-02.DOC <br />