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~~ ~ <br />_- • ~ III III III III IIII III <br />110 Enclosure <br />Permittee Name: <br />Permit No: <br />Operation Name: <br />Anniversary Date <br />Robert J. Kagie <br />M-79-102 <br />Kagie Pit <br />06/21/88 <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 />Division for annual fees due <br />Annual Report <br />Remarks: <br /> <br />r <br /> <br />~. <br />5~'gr~'ature <br />(Rev. 02/88) <br />5257E <br />0052f <br />JUN 13 1988 <br />!~i!NC t.~,~~ <br />I~ECI_AMfi'l r(~ni u!'!i i~~:V <br />~D <br />~3' <br />~~ \~ <br />& ~~' <br />