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999 <br /> ANNUAL REPORT ® ' <br /> PERMITTEE NAME: Elam Construction Inc f <br /> PERMIT NO.: M-79-075-HR <br /> OPERATION NAME: Chambers Pit <br /> ANNIVERSARY DATE: May 29, 1999 ^ ; j 'i . ,J <br /> V J ' <br /> ANNUAL FEE DUE ON ANNIVERSARY DATE: $550.00 $10netginela%&GeologY <br /> COUNTY: Garfield <br /> In order to ensure that our records are up to date, please attach your revised annual report map and written <br /> report to this annual report. Note that a written report is not necessary if the map addresses all the <br /> items listed in the attached instructions concerning mining disturbance and reclamation update. <br /> Please type or print the current contact person's name, mailing address, and phone number in the space <br /> provided: <br /> Contact Name: /NOMAS /a• Loa Liz Company: �c.4M C AN171¢Uc77Di.1/ LNG. <br /> Address:: /Zl S So. 77"S *f ref Phone No.: ( 970 ) Z¢L —53 70 <br /> Gi�rtic/ Go B/ro/ FaxNo.: ( 970 ) Z¢5 -7.7I6 <br /> Comments:: /l/o AG�i'Vi �ur�n o /^G�Oo 42 e vi o d. <br /> 9&224f 4 dE /0Z//Z y 9 <br /> Signature of Corporate Officer, or Owner Date <br /> f� ha/3�d APelO . <br /> INSTRUCTIONS ON BACK <br /> M 90NRMLNMSIERMN1 AF 01. <br />