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<br />Permit No: 51-153 <br />Anniversary Date: A°ril 5 <br />Operator: Southway Company <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check box(es)) <br />Check or money order payable to Colorado Mined Land <br />~ Reclamation Division for annual fees due <br />Annual Repart <br />Map <br />Remarks ,3 ~('I" e,~, ~ 01~7t'~ <br />Signed ~ <br />