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z_ ; .. <br /> <br />Permittee Name: Farnsworth Const <br />Permit No: M-82-154 <br />Operation Name: Farnsworth Gr Pit 2 <br />Anniversary Date: 11/05/86 <br /> <br />.. „_J <br />~~,_ ~ ~ , <br /> <br />R/i1fLED Lr11D <br />RECLEI~F ~T!Ol DI~JIS!0?' <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: ~n/,tJ L.! f1 L ~EPU,eT <br />Ov v <br /> <br />If/r~/~ <br />~'" `~`~ <br />~G <br />~-7 0~ / /o~ /G A <br />