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.~ <br />~ III IIIIIIIIIIIII III <br />_. <br />^, ;;y,..-:'~;m~~'~~lilfl„and 111 Enclosure <br />Permittee Name: Tezak Const Co Inc <br />Perm;t No: M-81-o80- MAY 211986 <br />Operation Name: TEZAK NO 2 PIT <br />Anniversary Date: 05 / 27 / 86 ~t .~(e f;.,,, ,.;p„ i . ,; <br />C F:;~t.,:a1 ~°i~:`e'3 .arc. <br />i}G~(f. Dft~~..~ t~ <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 : ~ `~l~9SYY1 `P _. _ ~ rl fl ~C` ,11C2iYr~l] - <br />Signature <br />S/a-- / ~~ <br />~. ~• <br />~% ~~ <br />