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.. ~: • <br />Permit No: 82-11 ~fr•,re~lp'~® <br />Anniversary Date: June 24 lC't~ro Y7 <br />JUN y 0 i984 <br />Operator: Hi l lco Rock, Inc. IAINED LAND RECLAMAT'~1n~ r1 <br />Colo. De t. of P~ ~ ._ ~ iISI0h1 <br />Please complete the following and return this form with your fees and •a_u,~i ~e~uurces <br />reclamation data. <br />Enclosed are: (Check box(es)) <br />~ Check or money order payable to the Colorado Mined Land <br />Reclamation Division for annual fees due <br />~ Annual Report <br />Remarks: ,Q,r/,v,~AL FLoc~O/,~c o/= 2//t=i2 i S <br />/~E.Jc=~i-J 4. ~i~PR/EL l7EF'oS~i S ffS OR/G/~/A-L <br />Pc a.v <br />Signature <br />6/~/~ r <br />~~~~ <br />~ ~e <br />