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s • <br />Permit rto: 80-49 <br />Anniversary Date: February <br />Operator: <br />Please complete the following and return this form with your fees and reclamation <br />data. <br />Enclosed are: (Check box(es)) <br />Check or money order payable to Colorado Mined Land <br />~~ Reclamation Division for annual fees due <br />~' Annual Report <br />Si fined, <br />C,% '~~`~~`r~~ ~~ RECEIVED <br />FEB ? 51°83 <br />MINED LAND RECLAMATION <br />COLO. DEP I. OF NATURAL RE50::'lCES <br />