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<br />~.. 3 <br />Permittee Name: <br />Permit No: <br />Operation Name: <br />Anniversary Date <br />Douglas O'Bannon <br />M-80-201 <br />O'Bannon Pit <br />10/23/88 <br /> <br />110 Enclosure <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check space(s) below) <br />~~ <br /> <br />Remarks: <br />Check or money order payable to Colorado Mined Land Reclamation <br />Division-for- annual- fees due <br />Annual Report <br />Till ocs ~3 ~9aa <br /> <br />Signature <br />(Rev. 06/88) <br />0052f <br />