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• III IIIIIIIIIIIIIIII • <br />999 <br />11? Enclosure <br />Permittee Name: Melvin Gieb ~~'~j ,,.~~~~ <br />Permit No: M-76-018- <br />Operation Name: GIEB PIT ~~T:1 6 <br />Anniversary Date: 10 / 17 / 85 <br />MlNEO LAND <br />RECLAMATION DIVISIO!`1 <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check space(s) below) <br />X Check or money order payable to Colorado Mined Land Reclamation <br />Division for annual fees due <br />X Annual Report <br />X Map <br />Remarks: <br />Signature <br />