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110 and 111 Attachment <br /> Permittee Name: Mr. Lancp Rarkar and Mr. Bob Barker R!C <br /> Operation Name: SC�GfJ 7I � e �'� ✓� <br /> Permit No: 77-417 Novo# <br /> Anniversary Date: Nnvpmhar 1 ANNO <br /> Colo.OlMi t A U 4l RaourcesN <br /> Please complete the following and return this form with your fees anc <br /> reclamation data. <br /> Enclosed are: (Check box(es) ) <br /> / Check or money order payable to Colorado Mined Land <br /> Reclamation Division for annual fees due <br /> ;&A Annual Report <br /> Remarks: <br /> ignature <br /> (Rev. 5/84) <br /> Doc. No. 1782 <br />