2008-09-25_REPORT - M2005033 - Laserfiche WebLink

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K F ) AL FEE and REPORT REQUEST PERMITTEE NAME: Coulson Excavating Company, Inc. PERMIT NO.: A-2005-033 OPERATION NAME: Gardels Pit ANNIVERSARY DATE: October 6, 2008 ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) COUNTY: Larimer sEp'9 2903 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 submit the annual fee, 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-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 may to this form. The Annual Report & Fee requirement is not met until we have received the following components: fee, report, and associated map. If no new disturbances or reclamation have occurred during the previous year and no new changes to the previous vear's map are necessarv. then no new map is required. provided that the Operator shall state this in the Annual Report. 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: Richard Coulson Permittee Name: Coulson Excavating Company, Inc. Address: 3609 North County Road 13 Loveland, CO 80538 Phone Number: (970) 667-2178 Fax Number: (970) 667-2193 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 Corpo to Officer, Owner, or Designee 4 tmNp Lz_ Wno fs Date