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-r <br />Permittee Name: <br />Permit No: <br />Operation Name: <br />Anniversary Date: <br />~~ <br />Melvin R Gydesen <br />M-82-020 <br />Lucky Strike Lode <br />05/25/87 <br />~~ <br />[~ a ~ 110 Enclosure <br />MAV z s Tsai <br />MINED LAND <br />RECLAMATION DIVISION <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 />- -Dir~zuirfur-annual fees-due"" - - --- <br />X Annual Report <br />Signature <br />(Rev. 02/87) <br />5257E <br /> <br />5/27 /~~ <br />~. ~• <br />~; ~~ <br />Remarks • (~(,l,~,C.D ~~ SY1/1.~,..~,~ ~ ~p ~ !~'~~(/ <br />