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<br />Permittee Name: <br />Permit No: <br />Operation Name: <br />Anniversary Date <br />R.E. Monks Construction Comp. <br />M-86-025 <br />Mitchell Mine No. 1 <br />03/19/90 <br />110° Enclosure <br />FEa 12 19.90 ~~ G. <br />REC-_,gMgT ~~ ND ~p.OJ <br />D1V(g~-~~ <br />Please return this form with your completed Annual Report and a check or <br />money order for annual fees due, payable to the Colorado Mined Land Reclamation <br />Division, 1313 Sherman Street, Room 215, Denver, Colorado 80203. <br />ANNUAL RE ~~: V~u~ C~`~ 1 ~~ <br />~[ <br />Signature <br />Jt~~ <br />~~ Jv, <br />-rte <br />