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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANDAL?FEE an PORT REQUEST <br />Cotter Corporation <br />/M-1977-300 <br />Schwartzwalder <br />September 28, 2008 <br />Z <br /> <br /> 1 <br />"SEP 2 <br /> <br />min; <br />E, art; <br />$$633.00 (Due on or before your anniversary date) <br />Jefferson <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, 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-year, 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 active operations ceased for the year, if any. <br />Please attach your revised written annual report and annual report map to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated may. If no new disturbances or reclamation have occurred during the previous year and no <br />new changes to the previous year's map are necessary, then no new map is required. provided that the <br />Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: <br />Gns G?9 V r a -r-t s <br />Permittee Name: Cotter Corporation <br />Address: 7800 E. Dorado Pl., Ste. 210 <br />Englewood, CO 80111 <br />Phone Number: ?n'«^ ???? - 7 2 O S.5-'4/- 6 z <br />Fax Number: (720) 554-6201 <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. Annual Report instructions are <br />enclosed. <br />Q? > <br />'z _? <br />Signature of Corporate Officer, Owner, or Designee <br />9 - <br />Date <br />M:\PERMITIMASTERDOCLJM ENTS/M-AF-02.DOC