2017-10-23_REPORT - M1986123

• Permit No: M1986123
• IBM Index Class Name: REPORT
• Doc Date: 10/23/2017
• Doc Name: Annual Fee/Report/Map
• From: Coulson Excavating
• To: DRMS
• Annual Report Year: 2017
• Email Name: JLE
• Media Type: D
• Archive: No

Pages ot3
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information on record). If this information is blank or not current,please type or print carnent contact informatia
Permtttee Contact Richard Uodk= }
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Address: 3609 North County Road 13
Loveland,CO 80538
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact: Richard Coulson
Company: Coulson Excavating Company,
Inc.
Address: 3609 North County Road 13
Loveland,CO 80538
Phone Number: [phone]
Fax Number:
Email Address:
Inspection Contact: Richard Coulson
Company: Coulson Excavating Company,
Inc.
Address: 3609 North County Road 13
Loveland,CO 80538
Phone Number: [phone]
Fax Number:
Email Address:
I,the undersigned,hereby state that the information provided in this report is true and accurate, and that site operations are
being conducted in accor ance wit . ision approv mining and reclamation plans.
V
Signa ur r i I Kee,tagrnorato/Of(icei,Owner,or D cumented Designee D afe
M-AF-01