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• - <br />III III III IIIIIIIIII 110 Enclosure <br />R~C~iVED <br />Permittee Name: <br />Permit No: Horn Ranches I{~c ~fp 11987 <br />Operation Name: M-83-102 ti <br />Anniversary Date: Horn Gravel Pik MINED)-AND <br />08/02/87 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 oue <br />Annual Report <br />Remarks:, <br /> <br />Signature ' <br />(Rev. 02/87) <br />5257E <br />