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<br />AN AL FELsan&P REQUEST <br />PERMITTEE NAME: Coulson Excavating Company, Inc. <br />PERMIT NO.: /M-1985-026 <br />OPERATION NAME: Challenger Pit <br />ANNIVERSARY DATE: January 31, 2010 <br />W <br />f CP-IVE® <br />4pN 2 0 2010 <br />Division of Reclamation, <br />+_0 Mining and Safety <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Weld <br />- --- According-to-C.R.S. 34-32.5--14-6-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 to_date _and during the preceding year, new disturbances 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 report 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 map are necessary, then no new map is required, 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 />Signature of Corpora Offic , Owner, or Designee <br />Diana Moneypenny, Secretary <br />January 19, 2010 <br />Date