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«~ ~ ~~, <br />Permit No: 79-34 <br />Anniversary Date: Ptay 26 <br />Operator: Farrington Contracting <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check pox(es)) <br />Gheck or money order payable to the Colorado Mined Land <br />~. Reclamation Division for annual fees due <br />_ Annual Report <br />rX <br /> <br />Signature <br />Remarks: I..J~ arc. L,..~,/r.~a >`Lc /K-w /~L.r.._._ ~.., a ~~ <br />