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_ i <br />999 <br />i <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />ANNUAL FEE and REPORT REOUES <br />Coulson Excavating Co., Inc. <br />M-1985-026 <br />Challenger Pit <br />January 31, 2002 <br />T RECE~VED <br />JAN 2 ~ 1002 <br />Division of Min~rals and Geology <br />$688.00 (Due on or before your anniversary date) <br />COUNTY: Weld <br />According to C.R.S. 34-32.5-I 16 or C.R.S. 34-32-I 16, each year, on the anniversary date of a permit, an operator <br />shall submit the annual fee, a report and map showing the extent of current dis[urba ces to affected land, <br />reclamation accomplished to date and during the preceding year, new disturbances that ar anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, the tes 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 report and annual resort mao to this form! Please note rhat nn <br />adequately labeled mop that clearly delineates mtd includes the above elements may since f~r a written report. <br />Division records indicate the following permittee contact information. Please verify an~ make any necessary <br />changes: <br />I <br />Permittee Con[ac[: Richard Coulson <br />Permittee Name: Coulson Excavating Co., Inc. ~ <br />Address: 3609 N. CR 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 Divis on, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instmc ions are enclosed. <br />~.A VLC1.rn_ „ram-~_...._.. SO.Q'_ <br />Signature of Corporal Offic or Owner <br />5r,ns«rxc..~ ~ R aCX~~ <br />Dates , <br />M: W E R M f Mt A 5T ER DOC U M E N TSU1- A F-01 <br />