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~ III IIIIIIIIIIIIIIII • ~ <br />999 <br />F. . <br />~~~~~ 110 Enclosure <br />Permittee Name: MAR 8 1985 <br />Domenic Leone Const <br />Permit No: M-85-008 MIiN~~ LA~i~.7 <br />AnniversaryaDate: Leone-Gardner Gravel RECLA~~.'fi~ Jf'JI~~ON <br />os/22/aa <br />Please complete the following and return this form with your pees 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 />Remarks: ~~ ~~,:~-~-~~ <br />~~-~~ <br />~Z~ ti ~ ~ `~a~ ~~.J <br />~~~~ <br />~~ ~ ~~ ~ <br />~ ~~~ ~~ <br />i~ ~-~~/ <br /> <br /> <br /> <br />Signature <br />(Rev. 02/87) <br />5257E <br /> <br />~~ <br /> <br />