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~-• .. <br />Permittee Name: <br />Permit No: <br />Operation Name: <br />Anniversary Date: <br />Southwest Properties <br />M-81-158- <br />FOREST LAKES PIT #1 <br />O1 / 26 / 86 <br />110 and 111 Enclosure <br />5' t~ ~5.~ ~~ J~`n r9 ~ w 1 ~~ <br />JAN 2 q ]980 <br />Please complete the following and return this form with your~~fees~an~'~ ~'".`~ ,`" ~~r~.~ <br />reclamation data. <br />Enclosed are: (Check sF~ace(s) below; <br />~/ Check or money order payable to Colorado Mined Land Reclamation <br />Division for annual fees due <br />V Annual Report: <br />i/~ ~/~ 6 <br />Gm-sg~~ <br />Signature ~~ <br />