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r` , • III III I III II IIII III • <br />110 and 111 Enclosure <br />i\. .'.:~ .~ ~~: <br />Permittee Name: Mountain Gravel & Const.Co. <br />Permit No: 83-28 <br />Operation Name: WALLACE PIT <br />Anniversary Date: February 23 <br /> <br />~.... .- _ . ,..5 <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check space(s) below) <br />~ Check or money order payable to Colorado Mined Land Reclamation <br />Division for annual fees due lg~O O a <br />~/ Annual Report <br />Remarks: % .~/E2~ ~f/~S C~~c~,c/ /V D <br /> <br />7?~/.S ~iT /ti / 9~5~ 02 T. O/fi~ <br />~~ <br />Signature , /G~ /O~C~/~~~/~ <br />a~ <br />31 ~~ ~ <br />~% ( ~ <br />