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sss <br />Permittee Name: Melvin Geib <br />operation Name: GEIB PIT <br />Permit No: 76-18 <br />Anniversary Date: October 17 <br />~• <br />~~~IL9~~T"~? Attachment <br />.~,, . 2 ~~ i~,,,t, <br />,,.~ , <br />_~ ~ ~"!C :JCL^..'J~.;iIDN OIVISIG~. <br />- ~ .i <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check box(es)) <br />Check or money order payable to Colorado Mined Land <br />Reclamation Division for annual fees due <br />r <br />~~ Annual Report <br />~ Map <br />Remarks: <br />Signature <br /> <br />!Rev. ~ ':i4) <br />Doc. f;.;. 1805 <br />