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~, III IIIIIIIIIIIIIIII ~ <br />Permittee Name: <br />Permit No: <br />Operation Name: <br />Anniversary Date <br />Berthoud Pink Stone <br />M-81-057 <br />Sprague-Red Lyons <br />06/10/87 <br />RECEIVEp Enclosure <br />JUN 241987 <br />MINED L,gNp <br />RECLAMATION DIV181ON <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check space(s) below) <br />/~ Check or money order payable to Colorado Mined Land Reclamation <br />-T"- Division for annual fees due <br />,~ Annual Report: <br />Remarks: (_,(~,,, ~~ ~.:-~-f' /~'l~/~,}JL.~ -• <br /> <br />'~ ~ Q~`S~ <br />Signa e <br />(Rev. 02/87) <br />5257E <br />~ ~a s~~~ <br />gym. ~ .~`'~ <br />~ ~f' <br />{mac <br /> <br />