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MOFFAT COUNTY CLERK AND RECORDER <br />221 W. Wctory Way <br />Craig, CO 81625 <br />(970) 824-9104 <br />MINING/RECLAMATION FORM <br />File Number <br />Drawer Number <br />Return Date_ I ~CYI(~j'l ~b~) <br />Mining and Reclamation Application for: c / / ~/ p <br />Name of Pit or mine: ~ 1TC/t~ / / 1" ~~R <br />Date on which inspection period is over and application may be retrieved by <br />Applicant: <br />Agent Signature: <br />For: <br />•ram,'..I,BY'''~w'IEIN~M~!RrOf"!'K"^ i« "~!1w 'A~ <br />K: . ~ <br />V `. t.. <br /> <br />Attest: County Clerk or Deputy <br />Mailing Address <br />