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it � • <br /> 110 and 111 Enclosure <br /> PermittNo Name: (�E C� 'VIFE s� <br /> Permit No: Nelson Construction Inc 11T�155 � ��zz�bKK <br /> Operation Name: M-78-208- <br /> Anniversary Date: SOHGAFFERRS/CRROSSING J UN 19 IS <br /> / 16MINED LAND RECLAMATION <br /> Please complete the following and return this form with your.,�f#.q%,r"O1 Pi^_;"'u( Rescerces <br /> reclamation data. <br /> Enclosed are: (Check space(s) below) <br /> Check or money order payable to Colorado Mined Land Reclamation <br /> Division for annual fees due <br /> Annual Report <br /> Remarks: A/a .46-aC44✓ iA/ Z-Aff ,CST#-A2 <br /> ExceoT Ro,c FPos,aw C"a,v'Ts L i <br /> w <br /> Signature <br />