2007-10-18_REPORT - M1986123 - Laserfiche WebLink

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ANNUAL FEE and REPORT REQUEST PERMITTEE NAME: PERMIT NO.: OPERATION NAME: ANNNERSARY DATE: ANNUAL FEE DUE: COUNTY: Coulson Excavating Compauy, Inc. M-1986-123 IGrtright Pit November 7 2007 RECEIVED OCT 18 2007 Division of Reclamation, $$791.00 (Due on or before your anniversary date) Mining and Safety Lorimer 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 aze anticipated to occur during the upcoming year, reclamation that will be performed during the coming yeaz, the dates for the"beginning of active operations, and the date active operations ceased for the yeaz, if any. Please attach your revised written annual reuort and annual resort maa to this form. The Annual Report & Fee requirement is not met until we have received the following components fee, resort, and associated man. If no new disturbances or reclamation have occurred durinc the orevioiialitear and no new chances to this in the Annual Report. 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 Richazd Coulson Permittee Name: Coulson Excavating Company, Inc. Address: 3609 North County Road 13 Loveland, CO 80538 Phone Number: (970) 667-2178 Fax Number: (970) 667-2193 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'Rgport instructions are enclosed. Signature of Corpo e Of cer, Owner, ore ('~~-~-~b~~ iio, aer~ Date ~.