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<br /> <br />Permittee Name: <br />Permit No: <br />Operation Name: <br />Anniversary Date: <br />~, <br />110 Enclosure <br />~ iii iiiiuiiiiiii iii <br />Frank Levkulich <br />M-85-082 <br />Rock Pit <br />12/30/86 <br />8 Ralph Knez <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enc i osed are: --(Check space(s)- below) - - <br />_~ Check or money order payable to Colorado Mined Land Reclamation <br />Division for annual fees due <br />Annual Report <br />Remarks: ~1~'L 7~ert_¢J -c/~ Cc~w Cc'~vvyw~ <br /> <br />JAN ^ 01987 <br />Vit.~ 1l. ~% ~., ~~. ~~~ <br />. ~{_~+- <br />Signature- / <br />1/~2~~~ <br />o~,yi` `~'` ~"_ <br />~~ <br />~-, <br />