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<br /> <br />iii i iii iii iniii iii <br />999 <br />110 and 111 Enclosure <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 />10/23/86 <br />~1!'T ~- ~' ZqR <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 />O i~ Cvr~rri~w <br />/o%~l~ <br />~Yvl. s~~ <br />~•~e <br />I <br />