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~- ,~ , iii iiniiiiiiiii iii <br />Permit No: 7g_pg3 <br />Anniversary Date: aril 24 <br />Operator: Walsenburg Sand and Gravel <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check box(es)) <br />~. Check or money order payable to the Colorado Mined Land <br />_ Reclamation Division for annual fees due <br />Annual Report <br />Remarks: G(/.~ ,Or~,~ ~,~.,~ iG ,cum-~ <br />,w '7tuL_,~ ~. <br />/~.~, <br />Signature <br />5 /a- /~ ~ <br />orr ~ . ~" <br />i <br />RECEIVED <br />APR 2 41984 <br />MINED IANp RECLAMnr~nN DIVISION <br />Colo. Dept. a1 ~yiu,a, h~~~urces <br />