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A~" ~ ~~ <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: Coulson Excavating Company, Inc. v~ <br />PERMIT NO.: M-1985-026 „/ <br />OPERATION NAME: Challenger Pit <br />ANNIVERSARY DATE: January 31, 2008 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Weld <br />w <br />®~ -- ~fl~ <br />D;~;~to~ <br />//'yfa ~~~ Jt~?'~e~?~~¢~ p ~'//f/~~~J, <br />•7 , 4~.ad~ Q'1~ V <br />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 <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />- -reclamation-accomplished-gate- axid=dui~~g~he-pr~eeding-year-,-nev~d~sturbances that -are- anticipated- to -occur . - <br />during the upcoming year, reclamation that will be performed during the coming year, the dates 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 reuort map to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred during the previous year and no new changes to <br />the previous year's man are necessary. then no new man is reauired, provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Richard Coulson <br />Permittee Name: Coulson Excavating Company, Inc. <br />Address: 3609 North County Road 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 Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />~LS~ .,.~5 1 V~cc~~~~cL~ a .. t 5.1~ o\~ <br />Signature of Corporate'~Office Owner, or De ignee <br />Q ~ t °~, o1CX3~ <br />Date <br />