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s s <br />Permit No: 77-223 <br />Anniversary Date: January <br />R~~~9~/I€D <br />FEB 31984 <br />MINED LAND RECLAMATION DIVISION <br />Colo. Uep[. of Natural Resources <br />Operator: <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 />~G Annual Report <br />,, <br />hlap <br />Remarks <br />11~-~67~y <br />Pp55,v~~'~ "~G"'~°' <br />5 5 ~,fi;o^, <br />CG r~llo~ "`~~ <br /> <br />vim, <br />