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-_ ~• :. <br />Permit No: 77-193 <br />Anniversary Date: November 22 <br />Operator: <br />Please complete the following and return this form with your fees arn7 <br />reclamation data. <br />Enclosed are: {Check box(es)) <br />X Check or money order payable to Colorado Mined Land <br />Reclamation Division for annual fees due <br />-%- Annual Report <br />~ iHap <br />Remarks It is the intention of the owner/operator to maintain this operation <br />in a producing state by continuing to engage in the extraction of <br />material through at least the next 12 months. <br />November 21, 1983 <br />Signed <br />RECEIVED <br />N'OV 2 51983 <br />MINED LAND REC(AMATIDN DIVIi~IDN <br />Cob. Dept. of N~turel Resourcrs <br />