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,. <br />Permit No: 77-560 <br />Anniversary Date: February 22 <br />Operator: <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 Colorado Mined Land <br />Reclamation Division for annual fees due RE <br />~ CE~~F~ <br />Annual Report <br />FE8 2 4'984 <br />Ml~p l~p~ REC <br />Map ~ALcINUM~rPesourcesON <br />Remarks <br />