2005-11-07_REPORT - M1986123

• Permit No: M1986123
• IBM Index Class Name: Report
• Doc Date: 11/7/2005
• Doc Name: Annual Fee/Report/Map
• From: Coulson Excavating Company
• To: DMG
• Media Type: D
• Archive: No

~rS~P~
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
c~ ~1
~ Coulson Excavating Company
MM 1986 123
Kirtright Pit
November 7, 2005
DECEIVED
~OV 012005
Division tf Minerals and Beth
$688.00 (Due on or before your anniversary date)
Latimer

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_content-disturbances_to_affected_]and,
reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur I
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 attarh ymn• revised written annnal rep_nrt and anmial report maw fn this form- Please note that an
adequately labeled map that clearly delineates and includes the above elements may suffice for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: 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 Corporate fficer, Owner, or Desi ee
~Dil. ~ ~D05
Dale