REP12918

• Permit No: M1986123
• IBM Index Class Name: Report
• Doc Date: 10/31/2006
• Doc Name: A Fee and Report
• From: Coulson Excavating Company
• To: DRMS
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

G sC.-
t/ ANNUAL FEE and REPORT REQUEST
PERMITTEE NAME: /
Coulson Excavating Company
PERMIT NO.: /
/ M-1986-123
OPERATION NAME: I{irtright Pit
ANNIVERSARY DATE: November 7, 2006
ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date)
COUNTY: Lorimer
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OCi 31 2006
/Division of Reclamation,
Mining and Safety
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 durin¢ the previous year and no new changes to
the previous year's map are necessary. then no new moo 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:
Address:
Phone Number:
Fax Number:
Coulson Excavating Company
3609 N. CR 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 farm along with your written report and map. Annual Report instructions are enclosed.
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Signature of Corporal Offic r, Owner, or Designee
Ord al`1 SOD Lc
Date