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• • iii iiiiiiiiiiiiiiu <br />999 <br />MOFFAT COUNTY CLERK AND RECORDER <br />221 W. Victory Way <br />Craig, CO 81625 <br />MINING/RECLAMATION FORM <br />FILE NUMBER ~`~-9-0 <br />DRAWER NUMBER -I <br />RETURN DATE <br />DATE <br />RECEIVED FROM <br />WHOSE MAILING IS <br />MINING AND RECLAMATION APPLICATION FOR: 1 \ <br />NAME OF PIT OR MINE 1 ~~ I~(LLl~pt~ 1 <br />DATE ON WHICH INSPECTION PERIOD IS OVER AND APPLICATION MAY BE JJJ <br />RETRIEVED BY APPLICANT: <br />ATTEST: COUNTY CLERK OR D <br />TELEPHONE NUMBER ~ ~. ~..~ - ~. ~ I <br />AGENT SIGNATURE `~_ <br />