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.' <br /> ~1CCL~ Q <br /> ~~ <br />~, <br />11 2 Attachment <br />~ <br />Permittee Name: J & M Schmahl <br />Operation Name: <br />Permit No: M-84-001 <br />Anniversary Date: Aril 4 <br />Please complete the following and return this form with your fees a d <br />reclamation data. <br />Enclosed are: (Check box(es)) <br />ICI Check or money order payable to Colorado Mined Land <br />Reclamation Division for annual fees due <br />I-I Annual Report <br />I_I Map <br />Remarks: ~, c--ol <br />erg' ~ `f-//- ~S f'adriLo ~ o/ ~ eon d..h1 <br />_,/ <br />So~NEsf ~i~.s <br />- - S ,So l~5 ~s "/A <br />C7ou e <br />! <br />L <br />Vu/1 L /P G.Cf <br />~CJ'd /j~lA S zc~i // (JP J~ f- n~ <br />// <br />~ S GSS i d~~ <br /> <br /> <br /> <br />Signature <br />(Rev. 5/84) <br />Doc. No. 1805 <br />~~ <br /> <br />