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f <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Ouray Associates, LLC <br />M-1997-084 <br />Memphis <br />February 2, 2002 <br />$251.00 (Due on or before your anniversary date) <br />Ouray <br /> <br />FEB 9 c 1002 <br />Division of Minerals and Ceologp <br />According to C.R.S. 34-32.5-I 16 or C.R.S. 34-32-116, each year, on the anniversary date of [he permit, an operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected I~,nd- <br />reclamation accomplished to date and-during-t c precc~ling year; new disturbances that are anticipated to occur <br />during the upcoming year, reclamation [hat 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 your revised written annual report and annual report map to this form. Please note that an <br />adegaately 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: James F. Poulos <br />Permittee Name: Ouray Associates, LLC <br />Address: 816 Fox Hollow LN <br />Golden, CO 80401-0908 <br />Phone Number: (303) 273-0342 <br />Fax Number: (303) 273-0342 <br />~s ~ G, - lt..,,,,, <br />rtzAn ,~ amt ~c~l ~aw ~s~.yl••r <br />Po~t,Yl9o <br />~Mtv X 7'13 ~ <br />9~a-SL~I -(~b~U <br />9'11 303 3suo <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 />Sign ure of Corporate Officer or Owner <br />i/ a/oz <br />Date <br />M SPERM frVv1ASTERD000MENT5w1-AF-01 <br />