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i <br />A, ~~~ IIIIIIIIIIIIIIII T <br />PERMITTEE NAME: David Bacon & Glenn Southwick <br />PERMIT NO.: M-86-007 <br />OPERATION NAME: Masonville Stone <br />ANNNERSARY DATE: March 11, 1999 <br />ANNUAL FEE DUE ON ANNIVERSARY DATE: $225.00 <br />COUNTY: Larimer <br />• ~~~ , <br />~~ ~~~ <br />~~~~ <br />RECEIVEC <br />MA,4' :' ~? i~33 <br />;iwslon of Mlnerais 8 Geology <br />In order to ensure that our records are up to date, please attach your revised annual report map and written <br />report to this annual report. Note that a written report is not necessary if the map addresses all the <br />items listed in the attached instructions concerning mining disturbance and reclamation update. <br />Please type or print the current contact person's name, mailing address, and phone number in the space <br />provided: <br />Contact Name: ~~P.yINSDU.`~-hWI~C,~. <br />Address:: 2.~~ ~nl ~~ FAt ~"'1 <br />fob ~ l03 <br />I;v~l~ ~ na icy, ~~~ 8~s~9 <br />Company: F1~SbI'1y1 ~~~ S~h~ <br />Phone No.: 0170 ~ S (~ g - 3 S ~ 9 <br />Fax No.: (q70 ~ 5 ~S~ - o(~ D a- <br />Comments:: ~h i - a 1-49 f D, f t sip ,~.,~, i~a r", n;~),c~,,~ ~ r~~1 <br />~~ID-q~ <br />Signature of Corporate Officer, or Owner <br />Date <br />Af : ~DN R Al LN7 A ST ER DN1-A F-01. <br />