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u <br />Permittee Name: Charles Devereux <br />Operation Name:. <br />Permit No: 78-221 <br />Anniversary Date: August 23 <br /> <br />110 and 111 Attachment <br />RECEIVED <br />AUG 18 1984 <br />MINED LAND RECLAMATION DIVISION <br />Colo. Depl of Natural Resources <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check box(es)) <br />Igl Check or money order payable to Colorado Mined Land <br />Reclamation Division for annual fees due <br />~-~ Annual Report <br />Remarks: >S~t;nn L.;iXYr;.;CnX;C~:=;~u:C:~~::g~:ia <br />-,. _ ;, _. <br />Signature <br />(Rev. 5/84) <br />Doc. No. 1782 <br />