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<br />Permittee Name: <br />Permit No: <br />Operation Name: <br />Anniversary Date: <br />~~ <br />N Colo Water Conservancy Dist. <br />M-81-08b <br />Borrow Area C <br />07/21/88 <br />111/112 Enclosure <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 />/ Map <br />Remarks: <br />`r ' 1.-. ~ : ;, '~', ~. <br />~~ - :: ~ ' <br />JUL 18 <br />;ylli ~rD lR~•~;V'tit'Ji: <br />i g a re tIEGLAM~"~ iQ, . <br />(06188) <br />0054f <br />