Laserfiche WebLink
• <br />_~~,~~~ <br />III IIIIIIIIIIII) III <br />' iu~lg'~g86 112 Enclosure <br />Permittee Name: <br />Permit No: <br />Operation Name: <br />Anniversary Date: <br />Niel sons Inc <br />9= <br />PIT <br />06/17/86 <br />c1 f of <br />"~'= ~. <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check space(s) below) <br />$350.00 Check or money order payable to Colorado Mined Land Reclamation <br />Division for annual fees due check No. 39GG_ _ [~ioso.oo~ <br />Annual Report <br />Map <br />Remarks' Annual Report and Piap pending in-house review. <br />Signature Douglas L. Conger, Engineering Geologist <br />cc <br />Cortez Pit, Engr., CMLRD <br />6 ~~,/~ <br /> <br />