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~~=,* : `' <br />Permittee Name: La I'oudre Sand & Gravel Inc <br />Operation Name: <br />Permit No: 83-90 <br />112 <br />/' `t/ <br />Anniversary Date: January 11 ~I <br />.~ <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check box(es)) <br />I"~ Check or money order payable to Colorado Mined Land <br />Reclamation Division for annual fees due <br />I_I Annual Report <br />I_I Map <br />RECEIVED <br />JAN 17 1985 <br />MINED LAND RECLAMATION DIVISION <br />Coto. Dept. of Natural Resources <br />Remarks' Annual report and map will be forwarded to you within <br />45 days. <br />LaPoudre <br />Signature <br />(Rev. 5/84) <br />Doc. No. 1805 <br />Gravel, Inc. <br />