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PERM1TTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <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 operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning of <br />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 Report & <br />Fee requirement Is not met until we have received the following components: fee, report and associated map. <br />If no new disturbances or reclamation have occurred during the previous year and no new changes to the <br />previous year's man are necessary, then no new map is required, provided that the Operator shall state this <br />in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the above <br />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: Randy Whicker <br />Permittee Name: <br />Address: <br />Phone Number: (719) 275 -7413 <br />Fax Number; (719) 275 -1669 <br />Si _gym of Corporate Officer, Owner, or Designee <br />Date <br />ANNUA FEE and 1ZEPORT4EOUEST <br />Cotter Corporation (N.S.L.) <br />✓ M- 1977 -300 <br />Schwartzwalder <br />September 28, 2008 <br />$1,150.00 (Due on or before your anniversary date) <br />Jefferson <br />Cotter Corporation (N.S.L.), Schwartzwalder Mine <br />0502 County Road 68 <br />Canon City, CO 81212 <br />If you have additional comments and/or information that should be provided to the Division, please provide it below <br />or attach it to this font along with your written report and map. Annual Report instructions are enclosed. <br />er4,19.er 6 <br />RECEIVED <br />SEP 2. 8 2011 <br />I Division of Reciamati011g <br />Mining & Safety <br />