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.. ,- ~ _ <br />a~~ ~ j <br />~ppm {y I:.M rl~ ~] <br />^a.e ~r-J in....J a--. L.~ <br />~~1AY 1 S 1983 <br />Permit No: 80-228 TRIANGLE ONE PIT n~i~,iE,-, i n~~iJ pi ~;~ ,~;~;.,i i;iN <br />Anniversary Uate: April ..~~y ~'`'" ', ~`~' ~ ~ ~' <br />Operator: <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check oox(es)) <br />Check or money order payable to Colorado t~lined Lano <br />_ keclamation Division for annual fees due <br />Annual Report <br />kemarks: <br />U G i . c cv `tQ~/J <br />~ ,. ~1 <br />~ c c 'V~ <br />Signature <br />5 ! c ~l ~~ <br />~ - ~. <br />L y ~~ <br />