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.., <br />112 Enclosure <br />Permittee Name: Union Carbide Corp <br />Permit No: M-77-296- <br />Operation Name: KING SOLOMON-DELORES <br />Anniversary Date: 09 / O1 / 85 <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: <br />Map <br />Signature <br />- SEP ~ ~ ~ti~: , <br />p,-s~ T ON Q V1S1ON <br />RECD-~`MA <br />