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MOFFAT COUNTY CLERK AND RECORDER <br /> 221 W. victory way <br /> Craig, CO 81625 <br /> (970) 824-9104 <br /> MINING/RECLAMATION FORM <br /> File Number f122 <br /> ' <br /> Drawer Number 2 <br /> Return Date 3o <br /> DatecpttO�l�t��14 Zo) r'O <br /> Received From ly ��Tien - l�� —�fu�c v� �tul�y� Cv1dwy� <br /> Mailing Address_ 5u <br /> 7 <br /> r� Cd %Z5- <br /> Mining-and Reclamation Application for: <br /> Name of Pit or mine: )50,, PI f <br /> Date on which inspection period is over and application may be retrieved by <br /> Applicant: <br /> Agent Signture: T "�-�--�------ <br /> For: <br /> Attest: County Clerk or Deputy: <br />