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<br />~ III IIIIIIIIIIIIIIII <br />At\J1VAL 19\lil Vail <br />PERMITTEE NAME: Coulson Excavating Co., Inc. '=~ECE ED <br />PERMIT NO.: M-1985-026 JAN 2 200 <br />OPERATION NAME: Challenger Pil &Gcow9Y <br />,;: on of Min als <br />ANNIVERSARY DATE: January 31, 2000 <br />ANNUAL FEE DUE ON ANNIVERSARY DATE: $550.00 <br />COUNTY: Weld <br />According [o C.R.S. 34-32-116(3)(a), each year, on the anniversary date of the permi , an operator shall <br />submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />reclamation accomplished to date and during [he preceding year, new disturbances th t aze anticipated <br />to occur during the upcoming year, reclamation that will be performed during the co ng year, the <br />dates for the beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach our revised annual re ort ma and written re ort to this annual a ort. Please <br />note that an adequately labeled map tkat clearly delineates and includes the above e meats mn~~ <br />suffice for a written report. <br />Please type or print the current contact person's name, mailing address, and phone nr~mber in the space <br />provided: <br />Contact Name: Richard Coulson, President Company: Coulson Exca ati <br />Address: 3609 North County Road 13 Phone No.: 970 667-2 78 <br />Loveland, Colorado 80538 FAX No.: 970 667-21 3 <br /> <br />If there are additional comments and/or information that should be provided to the D~vision, please <br />provide it on a separate sheet and attach it to [his report form along with your map a d/or written <br />report. <br />~I Vl ~y 1 .~ ~w v-~ ~ ~Fr Ta <br />Signature of Corporat Office , or Owner Date <br />INSTRUCTIONS ON BACK <br />Inc. <br />M ~PERMfM1ASTERD000A7ENTSVN-AF-01 <br />