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<br /> <br />• 112 Enclosure <br /> ~~~~~~ <br />Permittee Name: <br />Permit No: <br />eration Name: <br />O Bettger S & G <br />M-76-051- ~ <br />JU(V ~ Q <br />p <br />Anniversary Date: BETTGER GRAVEL PIT <br /> 05 / 06 / Bs ~1~'€nD LAND R~CL.,~h9aTI0fV <br /> ~,OIC.:lyA,~ e! -ia+_,.~t p~S4J!CE5 <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check space(s) below) <br />~ Check or money order payable to Colorado Mined Land Reclamation <br />Division for annual fees due <br />Annual Report <br />Map <br />• <br />Remarks: <br /> <br />grrature <br />