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• • ./,~ <br />]l0 and 111 Enclo~`[~1qsgJure <br />Permlttee Name: Chaffee County ~ i. ~/ ~ B <br />Permit No: M-85-091 <br />operation flame: Salida pit JAN 8 )39~ <br />Anniversary Date: august 21 MIND I~.AND <br />RECLAMATIOfd BIVISIdiV <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 far annual fees due <br />X Annual Report <br />Remarks; This pit has been used minimally since it was permitted. Only <br />~~ rock and pit run material has been removed and the only reclamation <br />that hac been done is minimal recontouring~and leveling <br />~. ~u <br />Signature <br />