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~... <br />_, <br />Illllllllllllllllll ~ ~ ~~ <br />110 and 111 Enclosure <br />RE ~~~~ <br />Permittee Name: <br />' Permit No: Domenic Leone Const <br />Operation Name: M-85-008- MA RI 1 1986 <br />Anniversary Date: LEONE-GARDNER GRAVEL MC;E~ ~~ ~ A <br />03 f 22 f 86 ~ulu• p~ ~~~"f.~~4QT~4 <br />pi. of~rtrp; a! Resaurcos~ <br />Please complete the following and return this form with your fees and) <br />reclamation data. <br />Enclosed are: (Check space(s) below) I~ <br />_~ Check or money order payable to Colorado Mined Land Reclamation <br />Division for annual fees due <br />~_ Annual Report <br />~~/.,.~~ <br />/I~~---~~c , <br />Signature <br /> <br />!i f~6 <br />~-~~V -0 <br />~~I~ <br />I -~ <br />