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<br />Permittee Name: <br />Permit No: <br />Operation Name: <br />Anniversary Date: <br />• <br />110 and 111 Enclosure <br />• <br />Thornburg Grav Oper <br />M-83-060 <br />Thornburg <br />09/27/86 <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 Min"ed Land Reclamation <br />Division for annual fees due <br />_~ Annual Report <br />Signature ~ ~y~~~''4 <br />.x:, , ±. <br />SEP 91986 <br />P~iW~;J ~,,~j~C q~CLA~+iATIOfV <br />Cofo• D~spY, of NaTUrgl 6~2sourc^s <br /> <br />