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• iii iiiiiiiiiiiuiii : _: ; .. <br />999 <br />' ~`~1 /112 Encl osure <br />~~~ ~,~~ <br />Permittee Name: Herman Rother 1988 <br />Permit No: M-85-173 FE~318 <br />Operation Name: ROTHER GRAVEL PIT MIINEp LAND <br />Anniversary Date: 02/03/88 ATIpN pIVISIOid <br />t~ECLAM <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclo/se/d are: (Check space(s) below) <br />v Check or money order payable to Colorado Mined Land Reclamation <br />Division for annual fees due <br />Annual Report <br />Map <br />Remarks: <br />Signature <br />(Rev. 02/87) <br />5257F <br />~~ ~~ <br />