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Illllllllllllllllll ~ _~ ~ <br />~. P i s tisa~ <br />Permittee Name: MINEQ LA(vG <br />Perini t No: Thornburg Grav Opel€^~ q~agT~~ey Q,~ac~n!,! <br />Operation Name: M-83-060 <br />Anniversary Date: Thornburg <br />09/27/87 <br />110 Enclosure <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check space(s) below) <br />~. Check or money order payable to Colorado Mined Land Reclamation <br />Division for annual fees due <br />~_ Annual Report <br />Remarks: <br />~~ <br />I ~ s,f ,~ ~i.-e. e--~c~L 1/l..P~i <br /> <br /> <br />Signature <br />(Rev. 02/87) <br />5257E <br />i~ / B <br />