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fAV * V,? - f <br />ANNUAL FEE and REPORT REOUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />Cotter Corporation v <br />M- 1979 -094 -HR <br />JD -7 Pit <br />December 14, 2009 <br />RE <br />V/ DEC 18 2009 <br />/ CU/ pbfteq of ReCIM&90►t, <br />� oft and W <br />$633.00 (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 year, on the anniversary date of the permit, an <br />- — -- operator -shall subnit-the =annual -fee, a= repor -t-and -mom= showing =the--e t_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 map If no new disturbances or reclamation have occurred during the previous year a nd no <br />new changes to the previous year's map are necessary, then no new map is required, provid 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: Glen Williams <br />Permittee Name: <br />Address <br />Phone Number: <br />Fax Number: <br />Cotter Corporation <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. Annual Report instructions are <br />enclosed. <br />Signature of Corporate Officer, Owner, or Designee <br />Date <br />M: \PERMII IMASTERDOCUMENTS/M- AF- 02.DOC <br />