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= ~ ;} <br />' ~ • III IIIIIIIII'llllll •• 110 Enclosure <br />Permittee Name: ~'+~~~ M G® <br />Permit No: Frank Levkulich 8 Ralph Knez D E <br />Operation Name: 85-082 C 3 1 1987 <br />Anniversary Dat~dck Pit MINED~,gND <br />12/30/87 RECIAMAT(pN DIVIg(pN <br />Please complete the following and return this farm with your fees and <br />reclamation data. <br />Enclosed are: (Check space(s) below) <br />_J~ Check or money order payable to Colorado Mined Land Reclamation <br />Division for annual fees due <br />Annual Report <br />Signature <br />(Rev. 02/87) <br />5257E <br />