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• III IIIIIIIIIIIIIIII • <br />112 Enc:lasure <br />Permittee Name: Melvin Gieb ~ <br />Permit No: M-76-018 <br />Operation Name: Gieb Pit <br />Anniversary Date: 10 / 17 / 86 ~''~'t~ ~~ rC~~ <br />~. <br />.`Cll. ,-. ,.:, .- , <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 due <br />Annual Report <br />x Map <br />Remarks: <br />gnature <br />