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~ • V <br />`? ~ ~ III III III III IIII III <br />999 <br />- 112 Attachment <br />I Permittee Name: _ Broderick and GibborrlT <br />Operation Name: F~h~a ~ h ~i f RECEIVED <br />Permit No: 81-307 DEC 2 Q )~flr1 <br />Anniversary Date: December 3 <br />MINED LAND RECIAM~pT)9AI AINISl9h1 <br />Colo. Oept. of N~4r~l ~ <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />~, Enclosed are: (Check box(es)) <br />Check or money order payable to Colorado Mined Land <br />Reclamation Division for annual fees due <br />I~I Annual Report <br />I_I Map <br />Remarks: <br />~n ~ ~ n <br />Signature <br />(Rev. 5/84) <br />Doc. No. 1805 <br /> <br />U11. ~ - <br />f •~ (e <br />1 ` <br />