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PERMITTEE NAME: <br />PERMPf NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />Bridalveil Construction <br />M-2001-054 <br />Bridalveil <br />October 28, 2004 <br />$281.00 (Due on or before your anniversary date) <br />Ouray <br />According_ta C.R.S. 34 32.5-116 or C.R.S. 34-32-116, each year, on_the anniversary date of thepermit, an operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />reclamation accomplished to date and during the preceding year, new disturbances that aze 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 operatons, and the date active operations ceased for the yeaz, if any. <br />Please attach your revised written annnal report and annnal report mad to this form- Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Emery L. Olin <br />Permittee Name: Bridalveil Construction <br />Address: 1796 N. Main St. <br />P.O. Box 1412 <br />Phone Number: <br />Fax Number: <br />Ouray, CO 81427 <br />(970)325-4674 <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 />Signature of Corporate Officer, Owner, or Designee <br />Date <br />