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~ III IIIIIIIIIIIIIIII ~ <br />999 <br />,~,~'_ y:;~r-, .-. _..1.10 and 111 Enclosure <br />~; , ~: . <br />Permittee Name: Rocky West Mining Corp_ <br />Permit No: M-82-058- ~ ~1'~I ~ 1~8~ <br />Operation Name: POORMAN MINE <br />Anni versary Date: 06 / 14 / 86 b - i ~ _ ~~ <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check space(s) below) <br />X Check or money order payable to Colorado Mined Land Reclamation <br />Division for annual fees due <br />X Annual Report <br />Remarks: NoT~cE of SWTBIVTIOr.) ~o CoN'riNVE MAN/r~C~ <br /> <br />Signature <br />~ ~a~~ <br />~•~ <br />~` ~G <br />