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• uii iiiniiiiii .► <br />Permit No: 76 -38 <br />Anniversary Date: July 25 <br />Operator: <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 />-L. Reclamation Division for annual fees due <br />Annual Report <br />Map <br />Remarks No mining or reclamation took place during the past year. <br />Sales were from existing stockpiles. <br />Sig ed Henry r President <br />UL � >'1983 <br />MINED LAND RECLAMATION <br />Colo. Dept. of Natural Resources <br />