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<br /> <br />~ III IIIIIIIIIIIIIIII <br />Permit No: 77-170 <br />Anniversary Date: October 1 <br />• <br />RECEIVED <br />OCT 131983 <br />MINED ~Y. <br />Calc ~ D RECLgMAnON DIVISION <br />pt. of Natural Resource; <br />Operator: <br />Please complete the following and return this forn with your fees and <br />reclamation data. <br />Enclosed are: <br />Check or money order payable to Colorado Mined Land <br />X Reclamation Division for annual fees due <br />Annual Report <br />X <br />hlap <br />X <br />Remarks: ~ New Map will be sent as soon as we <br />from the Engineer <br />it <br />Sign at <br />~~ /~ y~~ <br />~.G~'~ <br />r.'l <br />