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<br /> <br />112 Enclosure <br />Permittee Name: <br />Permit No: <br />Operation Name: <br />Anniversary Date: <br />Unitecl Sand & Gravel <br />M-81-058- <br />DEBEQUE PIT <br />09/07/85 <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check spa.ce(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: No activity has occurred_ nor ara rharp a,,.. „ia„~ rn ;,-^~yod ~lith <br />mining activities aC this site for the immediate future. <br />~e0t. <br />C <br />..c.¢ <br />Signature <br />