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4?7 i- p r <br />ANNUAL FEE and REPORT REOUEST <br />9 <br />PERMITTEE NAME: Bridalveil Construction gab Imm <br />PERMIT NO.: M-2001-054 <br />OPERATION NAME: Bridalveil ? OCT 2 6 .ZQ09 <br />ANNIVERSARY DATE: October 28, 2009 ng. <br />V D and Safety <br />ANNUAL FEE DUE: $323.00 (Due on or before your anniversary date) <br />COUNTY: Ouray <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 />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />di?g'C e m ear, rec a n a e e of rmea urmg a coming year, e dates or the egmning <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. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />man. If no new disturbances or reclamation have occurred durine 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: Emery L. Olin <br />Permittee Name: Bridalveil Construction <br />Address: 1796 N. Main St. <br />P.O. Box 1412 <br />Ouray, CO 81427. _ <br />Phone Number: (970) 325-4674 <br />Fax Number: <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 />gngnatur Corporate Officer, Owner, or Designee <br />I Z2 ?Z <br />Date/