2009-10-16_REPORT - M1986123

• Permit No: M1986123
• IBM Index Class Name: REPORT
• Doc Date: 10/16/2009
• Doc Name: Annual Fee/Report/Map
• From: Coulson Excavating
• To: DRMS
• Permit Index Doc Type: Annual Fee/Report
• Media Type: D
• Archive: No

ANNUAL FEE and REPORT REQUEST
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Coulson Excavating Company, Inc.
M-1986-123
Kirtright Pit
November 7, 2009
t
OCT 16 zoos
Division ci tseclzmation,
kl.,?ni:in end Safety
$$791.00 (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 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 map 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 year's map are necessary, 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:
Phone Number:
Fax Number
3609 North County Road 13
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 Corporate fficer, Owner, or Design e
?Cl-' 15 acx??
Date