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~iiiuuii~«~-ii-ii• ~ • <br />110 Enclosure <br />S ~ P 31981 <br />Permittee Name: <br />Permit No: First Bentonite Eo of~ MINED LAND <br />Operation Name: M-77-231 RECLAMATION DIVISION <br />Anniversary Date: Lbc Bentonite Pit <br />08/23/87 <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 - drL o uJ <br />Remarks: ~uE To 7ME S.nACc.UESS of o~Q O?cC.9T,oKJ +ac AQE <br />sT.~c woe,t~,•v(o c.~~cc. u,rr/,.,, ~vyeYS TN~r /I.oLE ,~xsr~J <br />I=oC UuE,2 ra (~EC~oI)E A,vl~ GE55 T/d•EN fd 7/~'r ~¢,QEr9 <br />7/fG PF_in,T AClows, Fog 7//E (p ,,,,,~~ yEf+2 .T. Cr+~v 5fE <br />NO Ct~NN(oG S /9 S Y/9Q AS 9wy NEW C+~+iJ ~9fFe-cTEI~ , 7XE l~E~i S,T <br />wG wof~ Noc.J louGJ GgST (~~ 70 ~.~c Z/F_AQS o2 rdDe~ w~TNU~% <br />/Ylo2c L,4.v~ J~t,N(p ArFccrEO, fIS r,o2 fl S /eEcC,y.nAT~oitJ cacE S 7N•S <br />YER~° t~E /1,R.ic WO~KcJ UrU A~1 VF.E6~ ~T 7f/,GY D,yTES A~C~ %U ~V8 <br />Drt~ DuP GGQ•m5 k1,Th` 43L M S ( CIdVON C/ry ~ S~DEC ~: S•on/ ,...~c /~/AUE <br />c,~r ~QTE,Q baQS TG,vN>e~ doV Y~•NON j~,vc A.vD SFE~)E.J Tt/E: Akt9 <br />wJ,rN W•t~) ScE,)_. G.),T// ADac1u~Y,c (n•QcW7~ >M/5 A~Lc'H- ShfX.[~ dE <br />?oT~'_~y QECLp,mE~, l,..)t in~tiClornG X^~Y iivsr~Eriion) ~dEn/ yo~~ ,.v j'~/E <br />~1R~h', <br />arc <br />Signature <br />(Rev. 02/87) <br />5257E <br />