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<br />/~ <br />b ~~~ ~ ~~~0~0-d~00~000~0 Q <br />AUG 2 71885 <br />Permittee Name: Albert R Frei MINED LAND <br />Permit No: M-83-033- RECLAMATION DIVISIOP± <br />Operation Name: WALSTRUM MINE <br />Anniversary Date: 06 / 23 / 85 <br />Pd ~ 350 ~ o e'~. <br />g~a~lss <br />c~ ~_~~09 <br />112 Enclosure <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check-space(s) below) <br />1/ Check or money order payable to Colorado Mined Land Reclamation <br />---bbb"`--- Division for annual fees due <br />V Annual Report <br />V Map <br />Remarks: <br />Signatu <br />