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r, <br />- ~ III ~II~II~II~~II III ~ '~ m2-.~ ~'°" L <br />sss ~ ~ ~~ <br />~~ <br />ANNUAL REPORT <br />PERMITTEE NAME: Jake Kauffman & Sons Inc D~~\ ?h~~ Q r gay <br />PERMIT NO.: M-78-327 "'() <br />OPERATION NAME: Kauffman Pit* <br />ANNIVERSARY DATE: May 14, 1999 ~~ECEIVEG <br />ANNUAL FEE DUE ON ANNIVERSARY DATE: $550.00 ti~;~1;i 2 5 'I$Sy <br />COUNTY: Larimer Division of Minerals & Geology <br />In order to ensure [hat our records are up to date, please attach your revised annual report tnap and written <br />report to this annual report. Note that a written report is not necessary if the map addresses all the <br />items listed in the attached instructions concerning mining disturbance and reclamation update. <br />Please type or print the current contact person's name, mailing address, and phone number in the space <br />provided: / <br />Contact Name:~~~~/t~ Company:~i~ Av`~~9.s~ ~'_Sn,U <br />Add/ress:: SAD/ g ~,y~_/9E Phone No.: (9ilL~ 1 loCo7 /SS? <br />/.~/>z! /~.f/ O/ C_'Dl~~) Fax No.: ~~JD 1 /i/o 7 - 998'.S~ <br />.3-icy' <br />Signature of Corpora e Officer, or Owner Date <br />INSTRUCTIONS ON BACK <br />M:~DNRhll.~h1A5TERD~M-AF 01. <br />