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ANNIiAi. FRF, and RRPORT RF,niiF.S T ~~rraarr fi~~ ~q <br />~•ry'iMt~II `1Y~1 <br />PERMITTEE NAME: Coulson Excavating Company <br /> _ <br />~" t 2 3 ~D~ <br />PERMIT NO.: M-1986-123 <br />OPERATION NAME: I{irtright Pit ~a ~..~__. <br />ANNIVERSARY DATE: November 7, 2003 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Larimer <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on [he 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 ymn• revised written annual refit and anm~al re~nrt m ~n to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the 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 <br />Address: 3609 N. CR 13 <br />Loveland, CO 80538 <br />Phone Number: (970) 667-2178 <br />Faz Number: (970) 667-2193 <br />- ---- ~ <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 />_.1~le,w"m-,--..~. Sor_, <br />Signature of Corpora Offi r, Owner, or Designee <br />~c~-~4~fz al 2.D~3 <br />Date <br />--- _MAPbRM343A}ASTER^^^• •..o~~fTT~`.:-AF _ _ _ _ -- - <br />