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3t-JWi-2~i 11:54 PapF~Lolorado Dlri[ion of q +u[IC i irolosy •13038328108 T-421 P 002/002 F20B <br />` ,'} <br />>~ ° r~ 'x: <br />,. ,.. <br />' , .,fi,~.;:: FEB 0 8 1006 <br />. . ~ l~i9 , <br />., <br />PER1NSPi'FE NAME: Sad B ~ Stoac . <br />PSR,i!dpC VQ.: M-ta Z-198 ~~y~ r ~?'t„~J . r <br />~RA'I'1pN NAMMa;;: Bw3 JE or 9tox <br />f ~•,.::a <br />. i , ANl~8N1ER.SARY DA'[1G: Ptbcts [a± 3, ZOOti ' <br />ANPT(iAL FEE DiJ6: 5281.[ 0 (Une w or beforo yov artoi+e[sarv dstc) <br />e [[port anc mep sbowing the extent <br />date end duri rg the lxeceding year, Her' <br />~ ~~ti' ~ rsoio~d writtee assn 1~=,t ^ d anneal rrmrt m.n t~rhia fecm_ Please nOIE thal a/1 <br />adequately labe/td rasp tllar clearly delirtea res artd includes the above elemenu may suJJlce for a written report. <br />Division records indicate the followiop, p~rmittec contact iniormanon. Please verify and [Hake say nxessary <br />changes. <br />Pamlttar 1C~~ontact , Ppa~b~lo Vasgtrcz <br />~ttee rialne: I3ad Boy 3teoe .}^f ~: y~~i'. <br />. ~ lV~~ -~•,1 <br />A~dclltcas: 11493 WCR 20 <br />' t n.N6t <br />Fort Ltlptotl, CO 80[5: 1 <br />_ .. Phone Numbs: (303) 857-4544 <br />Fax Number: (303) 772-9447 <br />If vw heez addrtiotral comments and/or i ifotmatian that should be provided to the Division, Please providC it <br />below or attach it to this fam along with r cur written repeat and map. Armual ltcport instntctions are rnclosed <br />~__.___ <br />Siglettue of / to Officer, Oatrxr, or ; hsigtlee <br />1 ~j. ~ ~ <br />Date <br />.> <br />