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<br />Permit No: 77-227 <br /> <br />~'~~~~~~ <br />FEQ?;19cl <br />Anniversary Date: February 9 PJIINED LAND R~CLP.il~ATIO'i rnVlSin!1 <br />Colo. Dept. of rl'atural resources <br />Operator: <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check box(es)) <br />~i Check or money order payable to Colorado Mined Land <br />Recla,nation Division for annual fees due <br />Annual Report <br />T/ Map <br />Remarks <br />,, <br />