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_ • III IIIIIIIIIIIIIIII r <br />999 <br />110 Enclosure <br />Permittee Name: Ron Ebberts ~ ~~~ ~ ~~ <br />Permit No: M-80-038 <br />Operation Name: Disappointment Valle N ~~ 2 1988 <br />Anniversary Date: 10/01/88 <br /> MINED LAND <br /> AMATION DIVI~IOW <br />RECI <br />Please complete the following and return this h <br />form wit your fees and <br />reclamation data. <br />Enc <br />lo <br />Sed are: (Check space(s) below) <br />' <br />L <br />{~ Check or money order payatile to Colorado Mined Land Reclamation <br />Division for annual fees due <br /> <br />Annual R eport <br />Remarks: <br />Signature <br />(Rev. 06/88) <br />0052f <br /> <br />