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,_, _ - <br />~~I II~IIIIIIII~~ ~I~ <br />sss <br />r~ "; ~ -t~ ^ ~11~'/112i~ Eficl osure <br />Permittee Name: flOV 231°87 <br />Permit No: Bear River Sand~Gravel - 7•~. ;:..;.:: <br />-= Operation Name: M-96-040 - <br />_. Anniversary Date: Bear River S & G rstC~.(~p•~~=~ ~`'~ ~- ~~ ~ ` <br />11/20/87 <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 <br />Annual Report <br />Map <br />Remo r/k~s : V V' ~ C l~ 0 Cl 0 2 i4 r - 1 _ <br />-_/v/ ~--- ~ (A 2 ~D C~'O C'~ ro Kl S P L~ ~ 't' - ,/P I^~<1' <br />~r u rr( <br />~l,~~/ ~,f1~P.~,c~ <br />SigSig-Tre ! ~/ <br />(Rev. 02/97) ~/~v, <br />5257E <br />