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M III IIIIIIIIIIIII III <br />Permittee Name: <br />Permit No: Delta Sand 8 Gravel <br />Operation Name: M-77-022- <br />Anniversary Date: PIT NO 3 <br />03/28/86 <br />ti <br />110 an~~j~~~ <br />MQR 181986 <br />Ml~+pp <br />Colo. Dew 09~at~Ql Ae` urces~ <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check space(s) below) <br />X Check or money order payable to Colorado Mined Land Reclamation <br />Division for annual fees due <br />Y. Annual Report <br />Remarks: See attached <br />re <br />DJ WQC~~Q P4 A <br />'//T~~'ome,//CoSSa?~JS \ <br />a'c(~rric ~• ~tc /iECS <br />g,,, pp ~ <br />s"' . SzJ . <br />