2004-11-01_REPORT - M1986123

• Permit No: M1986123
• IBM Index Class Name: Report
• Doc Date: 11/1/2004
• Doc Name: Annual Fee/Report/Map
• From: Coulson Excavating Company
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

~ANNiiAi. FF,F, and RF.PnRT RF.OiTFST
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Coulson Excavating Company
M-1986-123
ICirtright Pit
November 7, 2004
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i, ..,
$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
shall submit the annual fee, a report and map showing the extent of current disturbances 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 y~r revised written anneal report and anneal re~nrt maw 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: Richard Coulson
Permittee Name: Coulson Excavating Company
Address: 3609 N. CR 13
Loveland, CO 80538
Phone Number: [phone]
Fax Number: [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.
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Signature of Corpo to O ~cer, Owner, or Designee
~~o~f~ ~W~ ac~ay
Date