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<br /> <br />~~ <br /> <br />110 and 111 Enclosure <br />Permittee Name: <br />Permit No: <br />Operation Name: <br />Anniversary Date <br />Vida ;~ Sol berg <br />M-81-044- <br />JENS (I SOLBERG PIT <br />04 / (l7 / 86 <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check spaceis) below) <br />_~ Check or money order payable to Colorado Mined Land Reclamation <br />Division for annual fees due <br />Annual Report <br />Remarks: Annual Renort will follow no later than May 15, 1986 <br />Signature <br />