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} ~M <br />RECEIVED <br />AN1VTiAi. FF,F, and RF.PnRT RF,niJF.ST FEB 2 2 2006 <br />Division of Minerals and Geology <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />Coulson Excavating Company, Inc. <br />M-2000-156 <br />Bonser Pit <br />March 5, 2006 <br />$688.00 (Due on or before your anniversary date) <br />Lorimer <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 Tee, a report and map showing the extent of current disturbances to affected land, <br />reclamation acc"omplished-to -date and during the preceding yeaz, new disturbances that-are anticipated fo occui <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 ynnr revised written annual rep~nrt and annnal report m ~n to this form. Please note [hat an <br />adequately labeled map that clearly delineates and includes the above elements may cuff ce for a written report. <br />Division records indicate the following permittee contact infotmation. Please verify and make any necessary <br />changes: <br />Pennittee Contact: Ken Coulson <br />Permittee Name: Coulson Excavating Company, Inc. <br />Address: 3609 N. CR 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 />***WOrk at the Bonser Pit has not started as of this date. <br />11~tnawi_ ~a.,cw,.~..... <br />Signature of Corpora Offic ,Owner, or Designee <br />Diana Moneypenny, Corp. Sec. <br />Feb. 20, 2006 <br />Date <br />