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<br />L~ <br />Permit No: 79-10 <br />Anniversary Date: January 15 <br />L J' <br />Operator: AVERY S'I'RUC1l1RES, INC. <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 />~ Annual Report <br />,, <br />Map <br />Remarks <br />Signed Bill B. Cross, Project llanager <br />