REP00945

• Permit No: M2000156
• IBM Index Class Name: Report
• Doc Date: 2/17/2004
• Doc Name: Annual Fee/Report Notice
• From: Coulson Excavationg Company Inc
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

PERMTfTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Coulson Excavating Company, Inc.
M-2000-156
Bonser Pit
March 5, 2004
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RECEIVED
fig 17 2004
Glvlalon of Minerals & GeoloBY
$688.00 (Due on or before your anniversary date)
Larimer
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
- - -shaft-submit-tire-armual-fee,-a-report-and-map-showing-the-extent-of-current-disturbane€s--to-affected_land,-
reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur
during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning
of active operations, and the date active operations ceased for the year, if any.
Please attach ynnr revised written anmral re~nrt and anmial re¢prt man to this form. Please note that an
adequately labeled map that clearly delineates and includes the above elements may since for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Ken Coulson
Permittee Name: Coulson Excavating Company, Inc.
Address: 3609 CR 13
Loveland, CO 80538
- Phone Number:
Fax Number:
[phone]
[phone]
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this Form along with your written report and map. Annual Report instructions are enclosed.
**WOrk at the Bons has not been started as of this date.
1
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at re of orporata fficer, Owner, or Designee
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Date