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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Coulson Excavating Company <br />ii ~~~~6~~u~' <br />OC7' 2 3 2003 <br />M-1979-059 <br />Brownwood Pit <br />November 20, 2003 <br />''i:~isinn a/ f.7ieerals and Gaoio~ <br />$688.00 (Due on or before your anniversary date) <br />Larimer <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 />reclamation accomplished to date and during the preceding year, new disturbances [hat 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 />Pease attach y9yr revised written anneal re~nrt and anneal r~nrF m ~n to this form- Please Wore 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 />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 />~tY.Www__~Ovs~~cfl.. w., Se.~_ <br />Signature of Corpo to Of er Owner, or Designee <br />~r~-nb4~ ~.I ~db03 <br />Date <br />----M:V`ERM4'MIASl ER09EttMETFTS~M=AF-Bi - - __ _ - -'- <br />