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1 <br />M <br />_.. <br />Permittee Name: <br />Permit No: <br />Operation Name: <br />Anniversary Date <br />Harold Brandstadt <br />M-86-004 <br />Brandstadt Rock Pit <br />01/24/90 <br />M <br />110 Enclosure <br />Please return this form with your completed Annual Report and a check or <br />money order for annual fees due, payable to the Colorado Mined Land Reclamation <br />Division, 1313 Sherman Street, Room 215, Denver, Colorado 80203. <br />ANNUAL REPORT: <br />~z~e. >..~ ~ ~ , <br />Signature <br />