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~ ~/ <br />ANNUAL NEE and REPORT REQUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />/ Coulson Excavating Company, Inc. <br />~M-1979-059 <br />Brownwood Pit <br />November 20, 2007 <br />I- <br />RECFI~~Ep <br />/0~ ~ 8 200 <br />piviaion of Redamadon, <br />d Mining and Safety <br />$$791.00 (Due on or before your anniversary date) <br />Lorimer <br />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 <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />during the upcoming year; reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annual reuort and annual report man to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, reuort, and associated <br />maa. If no new disturbances or reclamation have occurred during the previous vear and no new chances to <br />the previous year's moo are necessary, then no new maa is required, provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Richard Coulson <br />Permittee Name: Coulson Excavating Company, Inc. <br />Address: 3609 North County Road 13 <br />Loveland, CO 80538 <br />Phone Number: (970) 667-2178 <br />Fax Number: (970) 667-2193 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />Signature of Corpora Offi er, Owner, or signee <br />\.f~ 1 t.. ~~07 <br />Date <br />