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• iii iiiiiiiiiiiuiii <br />• TELLER-PARK SOIL CUNSCR\'~ATIOPI <br />P.O. BO)i 85 <br />CRIPPLE CREcK, COtORAUO 80813 <br />RECEIPT FOR RECLAMATION PERMIT PACKET <br />A packet of information submitted by John 0. Buckner <br />containing copies of all the completed forms, maps, <br />permits and exhibits that collectively make up an <br />application to the State of Colorado, Mined Land <br />Reclamation Board, Division of Minerals and Geolog}', <br />for a Two-Acre Limited Impact Operation (110(1)) <br />Reclamation Permit has been received by the <br />undersigned agent and/or authorized person for the <br />under named agency, group, organization and/or <br />government authority on this the /)r~ of ;C~ 1993• <br />Signature and Title <br />