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r <br />MOFFAT COUNTY CLERK AND RECORDER <br />221 W. Wctory Way <br />Craig, CO 81625 <br />(970) 824-9104 <br />MININGJRECLAMATION FORM <br />File Number ~ 01~ <br />Mining and Reclamation Application for: (U~ <br />Name of Pit or mine: ~~ ~A 1 >~ <br />Date on which inspection period is over and application may be retrieved by <br />Applicant: <br />Agent Signature: <br />For: <br />'y . - .. K ee . rP ..r ~ r .. <br />Attest: County Cterk or Deputy: <br />. y <br />Drawer Number ~ o~ <br />Retum Date_r~ ~'~;1C~YL"~S <br />