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C~ <br />J <br />Permittee Name: Sterling Sand R Graval fn_ <br />Operation Name: THREE BELLS RANCH PIT <br />Permit No: 79-191 <br />Anniversary Date: October 13 <br />• ~ ~~,- <br />~~' ~• / <br />~/ ~. <br />112 A tt achment JJJ\\\GGG <br />F~'FI ~t`D <br />~~T •~,; <br />A/rn ~ <br />.. n,,,, .. ~..r~~;*i <br />"~31 PA;- ~1~r0~~ <br />. ~uurces <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 Colorado Mined Land <br />Reclamation Division for annual fees due <br />~`7pe •o ~ <br />I-I Annual Report <br />I_I Map <br />y~K <br />OG//~ <br />Remarks: the Annual Report and Map will be submitted by Rindahl & <br />Associates. <br />Signature <br />(Rev. 5/84) <br />Doc. No. 1805 <br />