REP33217

• Permit No: M1986123
• IBM Index Class Name: Report
• Doc Date: 10/18/2002
• Doc Name: 2002 Annual Report
• From: Coulson Excavating Company
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
ANNUAL FEE and REPORT REQUEST
Coulson Excavating Company
M-1986-123
Kirtright Pit
November 7, 2002
RECEIVEp
OCT 18 2D02
Division o} Minerals and Geology
$688.00 {Due on or before your anniversary date)
Larimer
According to C.R.S. 34-32.5-I 16 or C.R.S.34-32-116,-each year, on the anniversary date of the permit, an operator
shall submit [he annual fee, a report and map showing the extent of curnem disturbances to affected land,
reclama[ion-accomplished_to_date_and during the preceding year, new disturbances that are 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 your revised written annual report and annual report map to 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:
Petmittee Contact: Richard Coulson
Permittee Name: Coulson Excavating Company
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.
Signature of Corp ate ficer, Owner, or Designee
C'~-~r~~. ts, ems
Date

M:~PERM ITVNASTERDOCUMENTS~h1-AF-01