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~ IIIIIIIIIIIIIIIIIII <br />• <br />111/112 Enclosure <br />Permittee Name: <br />Permit No: <br />_~ Operation Name: <br />_, Anniversary Date: <br />Goodell Brothers Inc <br />M-77-522 <br />Herman Feit Pit <br />03/23/88 <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 fnr annual fPPS due <br />Annual Report <br />Map <br />Remarks: `7/p ~J721iywr~r_ 0'(_, /Jy~p~~-,-,a~o-,~ /~p~_ <br />i,Le~~- vr2 / 9 ~~/ <br />Signature <br />(Rev. 02/87) <br />5257E <br />a :~ ;:~ <br />4:~~ ~ ~ ..,,: - <br />--1,#HR " ~ 1998 <br />