2023-06-05_REVISION - M1979131

• Permit No: M1979131
• IBM Index Class Name: Revision
• Doc Date: 6/5/2023
• Doc Name: Request for Technical Revision
• From: JH Sand & Gravel, LLC
• To: DRMS
• Type & Sequence: TR3
• Email Name: ANM
• Email Name: JLE
• Email Name: AWA
• Media Type: D
• Archive: No

FOWLER STATE BANK 005727
JH Sand & Gravel, LLC 82-141/1021
Jim McCuistion
5960 COUNTY LANE 23
SUGAR CITY, CO 81076
[phone]
DATE AMOUNT
TWO HUNDRED SIXTEEN&NO/100
PAY 05/30/2023 005727 $216.00
TO THE
ORDER Division of Reclamation,Mining&Safety
OF
�un+onr�o siunnnus:
u000 5 7 2 WO 1: 10 2 10 14 1 2i: 60 L 04 4 71['