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<br />111/112 Enclosure <br />Permittee Name: <br />Permit No: <br />_.: Operation Name: <br />_. Anniversary Date <br />Coulson Excavating Co Inc <br />X23 M-~9[-1os9 \ <br />l~ IJ RO lil N 4b06 ~ ~'F <br />/1f .~o~S7 <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check space(s) below) <br />~_ Check or money order payable to Colorado Mined Land Reclamation <br />Division for annual fees due <br />* Annual Report <br />XX Map <br />Remarks• ~~Information as requested in letter as follows: <br />The current affected acres are 7.2 acres as shown on this •a2p, with h.2 acres <br />to be affected in the coming year. The number acres reclaimed are shown as <br />the 19.4 acres and 11.15 acres together for a total of 30.55. These acres have <br />been backfilled, graded, replaced with topsoil, but not reveQetated. Therefor, <br />no vegetation has been planted, no fertilizer. etc. has been used. and no <br />currect success can be measureds <br />(Rev. 02/87) <br />5257E <br />