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_ _ ~- <br />~ III IIIIIIIIIIIIIIII <br />999 <br />~ ~~f~~,~ <br />110 and 111 Enclosure <br />Permittee Name: Mountain Gravel & Const.Co. <br />Permit No: 83-28 <br />Operation Name: WALLACE PIT <br />Anniversary Date: February 23 <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check space(s) below) <br />Check or money order payable to Colorado Mined Land Reclamation <br />Division for annual fees due ~~~ ~ b <br />Annual Report <br />Remarks: / /T~/~-2~ ~f~//~ /~E~J ti b <br />~)CPE~'r TJ-1;s'i2~ w ~ ~ ~ r~~ L ~+~E~2 <br /> <br />Signature ~ Gs~ ~~ i Pc~icJ~~- <br />~i~~ ~ ~ <br />r `~ <br />