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1~ <br />. ~II ~I~~I~~I~~~~~~I~ <br />999 <br /> <br />R~~~a~9~® <br />FEB 819d~1 <br />Permit No: 83-28 <br />Anniversary Date: Februarv 24 <br />Operator: <br />tl~~?ED LAND RECLAMATION DIVISIO~~ <br />Colo. Dept. of Natural Resou:ce~ <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check box(es)) <br />/ Check or money order payable to the Colorado Mined Land <br />Reclamation Division for annual fees due <br />_ Annual Report <br />Remarks: GJ~ .~,qi/~ /iJOT YE~- <br />Signature <br />a (~'!~`~ <br />~.~~~ <br />~; re <br />