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ANNUAL FEE and REPORT REQUEST <br />PERMTTTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Cotter Corporation <br />M-1977-307 <br />CM-25 Mine <br />Apri130, 2006 <br />$225.00 (Due on or before your anniversary date) <br />Montrose <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each yeaz, on the anniversary 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 yeaz, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning of active operations, and the date acfive operations ceased for the yeaz, if any. <br />Please attach vour revised written annual renort and annual report man to this form. Please note that an <br />adequately labeled map that clearly de/ineates and includes the above elements may suffice for a written report. <br />Division records indicate the following petmittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Glen Williams <br />Permittee Name: Cotter Corporation <br />Address: <br />Phone Number: <br />Fax Number: <br />P.O. Box 700 <br />Nucla, CO 81424 <br />(970)864-7347 <br />(970)864-7287 <br />If you have additional comments and/or 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. Armual Report instructions are enclosed. <br />Signature of Corporate Officer or Owner <br />Date <br />