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. ~ ~~~ ~~~~~~~~~~~~~~~~ Nand <br />. ._ f <br />110 and 111 Enclosure <br />Permittee Name: Walsenburg S&g Inc <br />Permit No: M-78-283- <br />Operation Name: Sand Arroyo <br />Anniversary Date: 04 / 24 / 85 <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 />Division for annual fees due <br />Annual Report <br />Remarks: /~/J,wC ,O.i~../ /tr~fs....~i" nt a, <br />Signature <br />CG,ecGc s$ (~ 530 <br />ee <br />~~Sa <br />5/ 7/ 85 <br />Ar . ~-, ~° <br />~; /Q <br />