2001-11-09_REPORT - M1986123

• Permit No: M1986123
• IBM Index Class Name: Report
• Doc Date: 11/9/2001
• Doc Name: Annual Fee/Report/Map
• Permit Index Doc Type: ANNUAL FEE / REPORT
• Media Type: D
• Archive: No

011 ~I~~I~01~0~~~ DID
ANNUAL FEE and REPORT REQUEST
~~~~~~~®
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Coulson Excavating Company
M-1986-123
Kirtright Pit
November 7, 2001

~!OV 0 9 2001
Division of Minerals and Geology
$688.00 (Due on or before your anniversary date)
Larimer
According to C.R.S. 34-32.5-116 or C.R.S. 34-32-1 16, each year, on the anniversary date of [he 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 your revised written annual report and annual report map to this form. please mote that an
adequately labeled map shat c(ear(y delineates and includes the above elements may since jor a m•ritten report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee ContacL• 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.
Signature of C~orpor~e~r or Owner
IJn~~ 7 r ooI
Date
AI dPERA1rIN7A5TERDUCl1AtENTSV.1 AF~01