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110 and 111 Attachment <br /> Permittee Name: Mr. Lanre RRlarkpr and Mr_ Rob Barker <br /> Operation Name: _�¢,-) / / I ✓I e <br /> Permit No: 77_417 <br /> Anniversary Date: Nnvpmhpr 1 <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 /> A{a Annual Report <br /> Remarks: <br /> ignature <br /> (Rev. 5/84) <br /> Doc. No. 1782 <br />