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<br />Permit No: 77-284 <br />Anniversary Uate: June 6 <br />r~ <br />u <br />Operator: <br />~~ Please complete the following and return this form with your fees and <br />reclamation data. <br />i <br />Enclosed are: (Check uox(es)) <br />Check or money order payable to Colorado Mined Land <br />Reclamation Division for annual fees due <br />Annual Report <br />Remarks: ~~1E rn/~r2a) JU(- rn i`rr- euAS n~:e~f2~4 Cl~c.c r <br />}171. /982 - 83 SiffAe. ,i7i/ wc~.e~c wins ~r/t ~rrmr~ u.~ frr .eur/nd <br />UJ.t C' PaS Scar a~ec.. s ctPb/i.c1 ~~ <br />S~/Ct2,4_. le2,C/C.ftiY/tz~IJ~'1/ ~JCfL{Ov/Cl~t~ JN~I/ D/~SC77_/Zvi C7r', C[R/~Ea~ <br />s'CC (r ~GC C2 iS FY//7 o/ L/T//i 7 td yK. 7~!~' /~i/I///G~ l~ <br />