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,. -iii iuiiiiiiii~~iii ,~ <br />Permittee Name: Formaz & Son Inc ~ 2 ~ Aga <br />Permit No: M-78-305 F E~ <br />AnniversaryaDate: 02/22/88n Gran Pit MAN ~Op Up 151~~ <br />R~G4PMP <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 Reclamation <br />Di.vision__fnr annual fPP_t_tI~IQ <br />x Annual Report <br />Remarks: <br />14fl7-- Conx;sted of the beg;nn; of reclamation work on Phase 2 and the <br />minine of Phase 3 which will continue into ai,prox. the year 1990. <br />Signature <br />(Rev. 02/87) <br />5257E <br />~p©~~® 110 Enclosure <br />_v ` `' <br />