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= ! III IIIIIIIIIIIII III ~ <br />~1 ~ ~ ~ ! tl E ® 110 Encl osure <br />Perini ttee Name : -• S ~ P 11987 <br />Permit No: Robert Gerner <br />Operation Name: M-81-108 MINED LAND <br />Anniversary Date: Pablo Vasquez Stone RECLAMATION DIVI81ON <br />08/29/87 <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check space(s) below) <br />Check or money order payable to Colorado Mined Land Reclamatiop , <br />Division for annual fees due - -- - ' <br />I <br />i Annual Report <br />Remarks:®~~ G'l~u .~/~.az.~ t ~ 2 <br />O %d ~ n u n ~ ~i+--- P..t <br />Signature <br />(Rev. 02/87) <br />~' . 5257E <br />.\ <br />,\ <br />