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999 <br /> <br />Permittee Name: <br />Permit No: <br />Operation Name: <br />Anniversary Date <br />James L Treat <br />M-80-041 <br />Rock Gulch Grav Pit <br />04/03/87 <br />110 Enclosure <br />RECf~~V~® <br />APR 1 o tse~ <br />RECLAMATDLAND <br />ON DlVISfON <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 50.00 Check or money order payable to Colorado Mined Land Reclamation <br />Division fur annual fees due <br />x Annual Report <br />Remarks' Reclamation plan renains unchanged <br />Map attached indicating usage areas. <br />Si <br />(Rev. 02/{97) <br />5257E V <br />~'~ ~ <br />F ~~ <br />