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. ", = <br />Permit No: 79-215 <br />Anniversary Date: D1ay f:2 <br />Operator: <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check onx(es)) <br />x Check or money order payable to Colorado dined Land <br />_ Reclamation Division for annual fees due <br />Annual Report <br />Remarks: <br />LaPoud„rE~Sand $ Gravel, Inc. <br />Siynatl}f~e Secretary <br />