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<br />Permittee Name: <br />Permit No: <br />Operation Name: <br />Anniversary Date <br />iii iiniiiiuiii iii <br />David Goss <br />M-85-140 <br />Goss Sand & Gravel <br />01/24/90 <br />_!' <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 />~~ <br />~~~6 M ~~® <br />Signature <br />JAN 9 1990 <br />MINED LAA;p <br />RECLgMgTION DIVISIOW <br />