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RECEIVED <br /> AUG 18 1983 <br /> Permit No: 76-32 MINED LAND RECLAMATION DIVISION <br /> Anniversary Date: June 17 Colo. Dept. of Naturai Resources <br /> Operator: <br /> Please complete the following and return this form with your fees and <br /> reclamation data. <br /> Enclosed are: <br /> Check or money order payable to Colorado Mined Land <br /> Reclamation Division for annual fees due <br /> Annual Report <br /> Hap <br /> Remarks: ` �iP� <br /> ,CI /�5 T <br /> C.clozP,,,kz-' Ajz�X 7— <br /> Signature <br />