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~ 4i~ <br />•J .. ~ ~ <br />x' <br />1~ <br />u <br />C~ <br />110 and 111 Attachment <br />Permittee Name: <br />Operation Name: <br />Permit No: <br />Anniversary Date <br />John G. Horvath <br />77-546 <br />July 26 <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check box(es)) <br />~-~ Check or money order payable to Colorado Mined Land <br />Reclamation Division for annual fees due <br />~-~ Annual Report <br />Remarks: Qooroxlamtely 5(1^ yawls of ni+ ,.,,., ,._..ei tifl., ,..,,,_ <br />-----~--_- -~mavea <br />from this pit. 911 else remains tiie same as the past year. <br />,~p~~g ~as nn~~ ~een any reclamation work at this time due to the <br />limited amount of gravel removed. <br />gnature <br />(Rev. 5j84) <br />Doc. No. 1782 <br />