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MOFFAT COUNTY CLERK AND RECORDER <br />221 W. Victory Way <br />Craig, CO 81625 <br />,IUM Q 6 ?E85 <br />(970)824-9104 <br />MINING/RECLAMATION FORM <br />~s,aa:,e.~f.~F,~. <br />~vc}tcEr.€~.r~ea oy <br />File Number ~~ lJ <br />Drawer Number_ <br />Return <br /> <br />Received <br />Mailing <br />Mining and Reclamation Application for: <br />Name of Pit or mine: ~ ~ - Z- ~~~ <br />Date on which inspection eri is over and application may be retrieved by <br />Applicant: ~~~~ S <br />Agent Signatluore~1 ~~~~=e-c_~/ ~ <br />For: ~~~~~/ ~ ~, <br />Attest: County Clerk or Deputy: <br />