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r <br /> <br />r~ <br />u <br />Data of Servioe_ August 7____, !q 81 <br />person $?rv~d_ Vance Mills <br />(~12d5e orint name dnd tit121 <br />Si4naLJfe____ _ <br />(?orSOn SerV2d) <br /> <br />M["!EO ~~NO RECL~•4ci[0"! ~IV1S10N <br />N <br />~~ _ S ~~ <br />aY---~ --- - - <br />(autnorized repres tativel <br />Michael S. Savage, Reclamation Specialist <br />(dame and title - please print) <br />I,M~pR74.vT: PLEASE READ 7HE REVERSE S[OE OF THIS aaGE. <br />LOl79 C.R.S. L473, 34-33-123 <br />