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i / / ~! <br />~µ bd~. <br />(~p ~e u ' <br />Permit No: 7$_pg7 <br />Rnni versary Date: FebY'Udry <br />ess <br />R°CEIVED <br />FEB' 81983 <br />MINED LAND RECLAMATION <br />COLO DELI. OF NATU~iAL RESOL:2CE5 <br />Operator: <br />Please complete is e following and return this form with your fees and reclama- <br />tion data. <br />Enclosed are: (Check box(es)) <br />Check or money order payable to Colorado Mined Land Reclama- <br />tion Division for annual fees due <br />Rnnual Report ~~ ~ o ~ <br />/O Map /J `~J <br />Remarks ~/ ~ jC v S~ ~/{j-~ ~.2 ~l~r /~~'JZd / P <br />~h e R e L.(> ff $ ~U --n~i N N Y / nl 2J ~I ~-r J / '1~ <br />~~~~o ~~. <br />Signed, <br />~8-u,yNLSu,J/ ~~<v Otz3 s <br />