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- - • III IIIIIIIIIIIII III • <br />999 <br />110 and 111 Enclosure <br />Permittee Name: McFarland Const Co <br />Permit No: M-79-192- <br />Operation Name: <br />Anniversary Date: 10 / 14 / 85 <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check space(s) below) <br />y"~ Check or money order payable to Colorado Mined Land Reclamation <br />Division for annual fees due <br />Annual Report <br />Remarks: «. r /~ ~~ ~Z1~~~~T /i~~s.. <br />~ ~ ~ <br />~~ ~y lr ~~ ~ /., <'''% -~ -rte <br />/, <br />;, <br />~ ,~ <br />SSgnatur~ ) <br />'~ ~ / <br />/~,.~.~ ' wCl <br />- v, ..y -vp <br />~~ <br />// t.Of H3La~`BOgPU <br />y Cl oP~s~~ <br />7 ~ <br />