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• --=-- -~ <br />III IIIIIIIIIIIII III <br />sss <br />Permittee Name: ~4ountain Gravel & Corst Co <br />Permit No: h1-83-028 <br />Operation Name: Wallace Pit <br />Anniversary Date: 02/24/87 <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />110 Enclosure <br />Enclosed are: (Check space(s) below) <br />Check or money order payable to Colorado Mined Land Reclamation <br />Division for annual fees due <br />~/ Annual Report <br />~N~.Jvq~ ~EPo/i ~ <br />Re~marks: /f~fz~~ -Gr~L.~~ iVo 00~~.4~~5 /~ 7~i`/S <br />/'"/~ LfIST YE.~2 sG /tIAiP/C~T coNO/T~D.c/S <br />~E/~/iT. cJ~~ r~i~ oPESe,~TE n~2i~cJG 7tfc co~`i'i,J~ <br />YE,g2 <br />7 <br /> <br />v~H~Ar7UN C:y,. <br />~~, ,~ <br />Signature ~G~ ~iP~~/~~~ <br />a(ra-( ~7 <br />aYy~ , ~ ' " G <br />~`~~ <br />N ¢~K M. wI~S. <br />