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4b 7.. OlC <br />1P <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />VCotter Corporation <br />{/M 1977-300 <br />Schwartzwalder <br />September 28, 2010 <br />?S"tP 2 ? X010 <br />Division of Feclac 1 on' <br />NSiong <br />$$1,150.00 (Due on or before your anniversary date) <br />Jefferson <br />-- - - - According to C.R.S 34 32:5=116 or-C.R.S:I432=-t M each year, on fhe anniversary dite 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 vour revised written annual report and annual report man 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 and no <br />new changes to the previous vear's man are necessary. then no new map is reauired. 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 su„flce for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Gus Gaviet6 <br />l yldy 6 himer <br />Permittee Name: Cotter Corporation <br />Address: <br />-Fwteewood, GO- -R- 0-3- 11- <br />Phone Number: (:729)-M4.624.1 <br />Fax Number: (420"544281- <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 />/f CG bUA/may f <br />Signature of Corporate Officer, Owner, or Designee <br />9-/7- 2-0,2 <br />Date <br />to, am / F50) <br />?rL???.y s1u 5 <br />711- Z7S- 71113 (x Z10) <br />M.TUMIr"ASTERWCUM&nW-AF-02.WC