2003-01-22_REPORT - M1985026

• Permit No: M1985026
• IBM Index Class Name: Report
• Doc Date: 1/22/2003
• Doc Name: Annual Fee/Report/Map
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE
ANNUAL FEE DUE:
COUNTY:
Coulson Excavating Co., Inc.
M•1985-026
Challenger Pit
January 31, 2003
$688.00 (Due on or before your anniversary date)
Weld
According to C.R.S. 34-32.5-] 16 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,
~eclamatiuisaccompli3fied'to date and~uring`the preceding year,- ne~isturbances t at ah re 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!nur revised written anneal re~,pnrt and anmral report main 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 pemilttee.contact information. Please verify and make any necessary
changes:
Permittee Contact: Richard Coulson
Permittee Name: Coulson Excavating Co., Inc.
Address: 3609 N. CR 13
Phone Number:
-- Fax Number:
Loveland, CO 80538
[phone]
[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.
ignature of Corporate Officer, Owner, or Designee
Sua,~~ an ~s
1
Date
RECEIVED
JAN 2 2 2003
Division of Minerals and Geology
M:~PERMITNIASTERDOCUMENTSNI-AF-01