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t 1?f A AL FETE and PORT REQUEST <br />PERMITTEE NAME: C ulson Excavating Company, Inc. <br />PERMIT NO.: 2000-156 <br />OPERATION NAME: Bonser Pit <br />ANNIVERSARY DATE: March 5, 2010 <br />#71K <br />WONO <br />AR 05 2010 <br />DMOWn Ot ReGWMSWp' <br />MMM9 and Safety <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Larimer <br />t9l? <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 />rPcta,,, to inn acw,,,nlish .d_ Q 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 vour revised written annual report and annual report may to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred during the previous year and no new changes to <br />the previous year's map are necessary, then no new map is required, provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />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: Ken Coulson <br />Permittee Name: Coulson Excavating Company, Inc. <br />Address: 3609 North County Road 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 <br />below or attach it to this form along with your written report and map. <br />***There was no mining at the Bonser Pit in 2009 <br />***There will be no mining at the Bonser Pit in 2010 <br />L <br />Signature of Corpora Offi er, Owner, or Designee <br />Diana Moneypenny, Corp. Secretary <br />March ., 2010 <br />Date <br />provided to the Division, please provide it <br />Annual Report instructions are enclosed.