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~ III IIIIIIIIIIIII III <br />999 <br />Permittee Name: <br />Permit No: <br />Operation Name: <br />Anniversary Date <br />American Materials, Inc. <br />M-79-192 <br />Spotted Burro Pit <br />10/14/89 <br />~ e <br />~~CI,.A~~ q~1~~osure <br />OCT ? !I 1QE9 <br />MI~cD LEND <br />RECLAMATIC~M f11V!BIpN <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 />/~lo M,N~~oJ -~I~~s pe,-~o0 <br />/J o 2el~ama~~o~ ~l~Is P~riop <br />M,~2 S.~III Co~S~oere-r, vPe~J <br /> <br /> MINED LAND RECLAMATION DIVISION N~ 011145 <br />1313 Sherman, Room 215 ~, <br />Denver, Colorado 80203 DATE ~~~ <br />.(303) 866-3567 ~B~L <br />RECEIVED '' \\ -+,- ~ S <br />FROM r'~~T~C~u1`E9. ~r-~ I~~Q 10 '~ ~~ 'J l_~ . ~ <br /> c- <br />`` <br /> ~~ D <br />- - - <br /> ~ I °} c?~-_ _ <br />DOLLARS <br /> <br /> ^ CASH <br />FOR C ~ I ° ~~ .,7'. ~ $,[d <br />D <br /> . <br />. <br />AMOUNT OF A COUNT...........5 <br />~ ~^ <br /> ~ <br />l <br />A~ ~U <br />AMOUNT PAID .... ........... ....$ <br />/ u <br />. <br /> / <br />- <br />BALANCE OUE .... .......... ...5 BV . <br /> <br />i~ i / vim-/' /~ ilJ~ol./~ <br />Signature <br />