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- - • • Lo~` <br />Permittee Name: Ralph Carestia <br />Permit No: M-81-036- <br />Operation Name: Carestia Pit <br />Anniversary Date: 04 / 02 / 85 <br />--r 110 and 111 Enclosure <br />l~ ....'..,.~..~ <br />A~~ ~ ac i~a~ <br />i,.,l ...i ~.,•„ ~~,. <br />.~. ~., .. ~, i:,,,~~Gl f,,~.:.rC°s <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed-are: -(Check space(s) beTowj- - --- - - - - --- -- --- -- <br />~` Check or money order payable to Colorado Mined Land Reclamation <br />Division for annual fees due <br />Annual Report <br />Remarks: Map of work done <br />~ T! l~~/~"/~S <br />Signat re ~ <br />~~` ~e- <br />.~-- <br />