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• • III IIIIIIIIIIIII III ~ ~ <br />Permittee Name: Harold Brandstadt <br />Permit No: M-86-004 <br />Operation Name: grandstadt Rock Pit <br />Anniversary Date: O1/24/RR <br />Q ~ ~ ~ O1~~Dsure <br />u i JAN 1s ~s~e'"a <br />MINED LAND <br />RECLAMATION DIVISION <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 />Remarks: Q.~ ~~, ~~ ~~ <br />i a / i <br />Signature <br />(Rev. 02/87) <br />5257E <br />,i I <br />~: <br /> <br />