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<br />III Illlllllllllllll <br />Permittee Name: 999 <br />Permit No: Jelen 8 Son inc <br />Operation Name: M-83-011 <br />Anniversary Date: Willow Creek Mine <br />02/23!88 <br /> <br />110 Enclosure <br />~~~~a~~® <br />fEB 231988 <br />MINED LAND <br />RECLAMATION DIVISION <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check space(s) below) <br />x Check or money order payable to Colorado Mined Land Reclamation <br />__ _ _ __ _ _ Division fnr annual fees d~~e L3<, ik17?78 <br />Annual Report <br />Remarks' Filling, sampling and testing were done during this <br />period. <br />Signature <br />(Rev. 02/87) <br />5257E <br />v'~ <br />