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• <br />Permittee Name: Thomas F and Ginger L Latham <br />Permit No: M-•81-058 <br />Operation Name: Dc~beque Gravel Pit <br />Anniversary Date: 0<_~/07/87 ~` <br />• <br />III IIIIIIIIIIIII III <br />111/112 Enclosure <br />~~~~ ~~® <br />Please complete the following and return this form with your fees ~hd~ <br />reclamation data. 8 197 <br />Enclosed are: (Check space(s) below) AEC MprO ~h~$lpN <br />// Check or money order payable to Colorado Mined Land Reclamation <br />Division for annual fees due <br />Annual Report <br />Map <br />Remarks: <br />signature <br />(Rev. 02/87) <br />5257E <br />