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• <br />., <br />Permittee Name: <br />Permit No: <br />Operation Name: <br />Anniversary Date <br />Jean M, and Dee Blue <br />M-81-207 <br />Blue Pit <br />03/08/89 <br />~ III Illilllllllll III <br />111/112 Enclosure <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 Reclamation <br />Division for annual fees due <br />Annual Report <br />~ Map <br />Remarks: <br />oP ~:~~ <br />Signature <br />