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- ~ III IIIIIIIIIIIIIIII~ <br />999 <br /> <br />110 and 111 Enclosure <br />Permittee Name: <br />Permit No: <br />Operation Name: <br />Anniversary Date: <br />Bentonite Co First <br />M-77-231- <br />LBC BENTONITE PIT <br />08 / 23 / 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 Reclama~ ~n,~ <br />Division for annual fees due ~yyyryy~~~ ~, <br />H n~~~D .~'S3w <br />Annual Report <br />AUG 2 31;.~-~ <br />MINED Lk~~ ~~' <br />RECLAMATION i~ivi5i0ti <br />Remarks: 5/2 5, $rNCG eol2 t~tT' /S A VEC~ S•srAi-C CowcE,eN <br />fir' ~- ~Rd56M' 7'i..oE r T.ilF~E t3 wet 7'0 ~/luc,/f ro ~[/o~2r <br />wr /lar.E ~AJr.~Gt~ n/o ~oP.t=' TN£./ ,30o To./~5 , c.J/FicN /lAS .vaT- <br />/IA~D r0•u^ CFt=Ecr o,~l orlE ~~y' A26i4 _ Ti~E piT' ~QEi4 //45 iQ~p1~~ <br />~AZ rCq >/M 5.4••rE FoQ TEN y~'rOR 3 _ ~2,,.J b 7I~ ('~ w9_ ~w/ r ~vyciHe <br />~.1E D~ x~oY' Ey~FCT 7o A'FrccT AMr /vCtJ Gown woT t9t.P_F.40~t <br />LDtuawDED Foe PRcD~c~~v`• QGT/,fw 6N A S,u.OG(. oPE2,ot+o.~/ ~..~~: <br /> <br />812E /rvy(6~NE1) Rt3wr" T//t ('iyUt,QuNm6nJjg G 1MOAGT WF <br /> <br />(_QF19TF A~vu we ~.~ .~ ~ ~1Zo [~p~ GJrTII~ Ov /Z ~tNE SS t~.lrTiJt <br /> <br />1/tc tDe•4 oi- Con.pLErE QELLA rbaTipr/~ 1'o A STATE 7.S1aT <br /> <br />W~tC Bra $G/1~~ 7Naty T/StC ( rlwy OQ~V~•vlG Gy L`/'FEcT'ED, <br />Signature <br />