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Permit No: 77-500 <br /> Anniversary Date: June 29 <br /> Operator: <br /> Please complete the following and return this form with your fees and reclamation <br /> data. <br /> Enclosed are: (Check box(es)) <br /> / Check or money order payable to Colorado Mined Land <br /> av- ,f Reclamation Division for annual fees due <br /> Annual Report <br /> Nor: <br /> Remarks �� �onN ���eCyi o� dua, ry Drtdl Dui /,/-Ccer ; 1 <br /> 1, 7 e aCeai4 rood 76 Ae/m�nG waste Clco�.�Qnu M w ee <br /> A A4e minim was /ano./e%Lgnd owe .ics rwound in AAe_ bar<fa,sa <br /> /n f-he eat r; )I, <br /> n r e= )`e <br /> l• if Uran.�.., /'iCarl4ave an y� Y r <br /> C 2aa of 19 accr5s- oad n* fDTTT <br /> _ ✓kuJer�a y SO a >'/Nc/i CAIn 0u// /"A9 <br /> Signed, <br />