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• ~ • <br />• <br />• <br />Notice of Intent to Continue Mining Operations <br />110(2) Annual Report <br />Permittee (lame: <br />Permit No: <br />Operation Name: <br />Anniversary Date: <br />Annual Fees for the Year(s) <br />Total: <br />veil's Excavating <br />M-80-143 <br />Texas Creek Grav Pit <br />10/27/85 - 10/27/90 <br />1985, 1986, 1987, 1988, 1989, and 1990 <br />5300.00 (DUE BY JANUARY 4, 1991) <br />(Annual fees will be due again on October 27, 1991) <br />Please return this form with your completed Annual Report and a check or <br />money order for annual fees due, payable to the Colorado Mined land Reclamation <br />Division, 1313 Sherman Street, Room 215, Denver, Colorado 80203. <br />ANNUAL REP(1RT: <br /> <br /> <br />Signature: <br />Please list: current address and phone number below: <br />Please type or print <br />Contact Name: <br />Address: <br />Date: <br />Phone: ( ) <br />