2006-01-31_REPORT - M1989056

• Permit No: M1989056
• IBM Index Class Name: Report
• Doc Date: 1/31/2006
• Doc Name: Annual Fee/Report/Map
• From: Coulson Excavationg Company Inc
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNTVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
/ANNfiAf, FF.F, and RF.PnRT RF,t7iTFST
L Don Kehn Construction, Inc.
~M-1989-056
Timnath Pit
February 24, 2006
RECEIVED
JAN 3 1 2006
i/Oivision of Minerals and Geology
$688.00 (Due on or before your anniversary date)
Larimer
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 sulimit the annual~ee, a report and map showing the extent of current disturbances to affected land,
reclamation 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 far the beginning
of active operations, and the date active operations ceased for the year, if any.
Please attach your revised written annual rennrF and annual red nrt m ~n 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:
Permittee Contact: Don Kehn
Permittee Name: Don Kehn Construction, Inc.
Address: 6550 S. CR 5
Fort Collins, CO 80528
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.
It-~-----. ~...r.~-- 1 Mo
Signature of Corporate Officer, Owner, or Designee
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Date