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i III IIIIIIIIIIIII III ~ <br />999 110 Enclosure <br />Permittee Name: David Goss r` ~;~ `~ <br />Perini t No: M-85-140 ~ ~- ~ ~' ` t~ t~'° <br />Operation Name: Goss Sand & Gravel ' <br />Anniversary Date: O1 /24/88 JAN ? 2 1988 <br />MIND LAND <br />LiECI_AMATION DIVISION <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Encl,osed/are: (Check space(s) below) <br />!~ Check or money order payable to Colorado Mined Land Reclamation <br />_ Di visi.on_for_annual_fegs-d~~e ------ - - <br />Annual Report <br /> <br />Remarks: }~ p ~. ~ u/ ~ S <br />hui ~ i <br />I '~-'~D <br />/? f ~ <br /> <br />5257E <br />V'" <br />