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<br />s <br />RECEIVED <br />OCT 27 15;~s <br />Permit No: 80-135 MINED <br />LAND RECLA~+nT~n" ^~~tSION <br />Anniversary Date: October 7 Colo. Dept. of Na,,,,,,, ,,~, ~ <br />ces <br />Operator: ~~~~~ ~~~ o, <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: <br />JG Check or money order payable to Colorado Mined Land <br />Reclamation Division for annual fees due <br />Annual Report <br />flap <br />Remarks: <br />Signature ~ S- ~ ~ <br />