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Permittee Name: <br />Permit No: <br />Operation Name: <br />Anniversary Date <br /> <br />James L. Treat <br />M-RO-041 <br />Rock Gulch Grav Pit <br />04/03/88 <br />`~ III IIIIIIIIIIIIIIII <br />~~~ ~~`~. <br />1`~..~_.1 ~ ~_ , <br />L~~YF_ ,~ I, AV*:~ <br />110 Enclosure <br />(~4AR 3 0 19b8 <br />iv;';1~'.~ ~.i'uc? <br />REGLF:tJ'" , IUfE Df1!ivlJN <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check space(s) below) <br />x $50,00 Check or money order payable to Colorado Mined Land Reclamation <br />Division for annual fees due <br />x Annual Report <br />Remarks: Reclamation glan remains unchanged <br />Man attached indicating usage areas. <br />