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~ III Illlflllllllllll ~ <br />~j~~"~G~~l ~~and 111 Enclosure <br />Permittee Name: Mt Gravel 8 Const Co ~~ B 2 2 <br />Permit No: M-83-028- <br />Operation Name: WALLACE PIT P.~i~~~ii ~~~ R~Ct~P•~ATl~N <br />Anniversary Date: 02 / 24 / 86 ~.• ~,;, fip~,;:,, ; <br />Piease 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 />Remarks: ~P~~2~~7o/r/S ,yg ~/'~ iCJ~y~~ <br />Goy--r..y~ir/~~`O i.y l~r~ .Dii, ~oW~i/~ <br />~orr~ ~yTZ/iP~ Ti~h~ . <br />~~~~ <br />Signature <br />a/~~-/~6 <br />~n.~ <br />~` ~e <br />