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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Permittee Contact: Glen Williams <br />Permittee Name: <br />Address: <br />Phone Number: <br />Fax Number: <br />Date <br />6,4.4 <br />/// <br />Cotter Corporation <br />P.O. Box 700 <br />Nucla, CO 81424 <br />(970) 864-7347 <br />(970) 864 -7287 <br />Signature of Corpo rate )..e... , Owner, or Designee <br />M APERMITMASTERDOCUMENTS/M- AF -02. DOC <br />ANNUAL FEE and REPORT REQUEST <br />V Cotter Corporation <br />M- 1979 -094 -HR <br />JD -7 Pit <br />December 14, 2011 <br />$1,150.00 (Due on or before your anniversary date) <br />Montrose <br />RECEIVED <br />-" Nov 25 2011 <br />Division of Reclamation, <br />Mining & Safety <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; reclattiatii�n accompiished date�and`dtTing ea`r <br />the precedingy t ew disturbances that are anticip ed 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 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 />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 />. A-� <br />