|
<br /> ANNIIAi. FF.F, and RF.PnRT RF,niiF,S T ~ a
<br />~~~~~ V ~~
<br />PERMITTEE NAME: Coulson Excavating Co., Inc.
<br />PERMIT NO.: M-1985-026 DEC ? 2 y~
<br />OPERATION NAME: Challenger Pit Division of Minerals
<br /> and Geoiop~
<br />ANNIVERSARY DATE: January 31, 2004
<br />ANNUAL FEE DUE: $688.00 (Due on or before your anniv ersary date)
<br />COUNTY: Weld
<br />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
<br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land,
<br />..............................r...,...,...,, ..,..,, ....,...,.....b ...., Y..,.,.......b ~.,»., ...,.. ....,.....,,...,,.,., ...,.............,,.r...,,,..., .,....,,.
<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 ym.r revised written anneal rennrt and anneal relyprt man 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 Co., Inc.
<br />Address: 3609 N. CR 13
<br />Phone Number:
<br />Fax Number:
<br />Loveland, CO 80538
<br />(970) 667-2178
<br />(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 instmctions are enclosed.
<br />Signature of Cor rate O icer, Owner, or esignee
<br />1~~. 191 aGi~3
<br />Date
<br />M:\PERMITN4ASTERDOCUM ENTS\M-A r-01
<br />
|