2017-09-22_REPORT - M2005033

• Permit No: M2005033
• IBM Index Class Name: REPORT
• Doc Date: 9/22/2017
• Doc Name: Annual Fee/Report/Map
• From: Coulson Excavating Company, Inc
• To: DRMS
• Annual Report Year: 2017
• Email Name: JLE
• Media Type: D
• Archive: No

Page 5 of 5
Division records indicate the following permittee/landowner contact information(blank fields indicate that we do not have
information on record). If this information is blank or not current,please type or print current contact information:
Permittee Contact: Richard Coulson
Permittee Company: Coulson Excavating Company,
Inc.
Address: 3609 North County Road 13
Loveland, CO 80538
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact: Peter Wayland
Company: Weiland, Inc.
Address: P.O. Box 1921
Lyons, CO 80540-1921
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Inspection Contact: Richard Coulson
Company: Coulson Excavating Company,
Inc.
Address: 3609 North County Road 13
Loveland, CO 80538
Phone Number: [phone]
Fax Number: [phone]
Email Address:
I,the undersigned,hereby state that the i ation provided in this report is true and accurate, and that site operations are
being conducted in accor nce with t D' ision approved mi 'ng and reclamation plans.
ignatur f Yer ig&torW6te Offic r,64er,Wfiocumented Designee Dad
M-AF-01