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iii ~i~iii~~~i~~i iii • <br />' 110 Enclosure <br />Permittee Name: ~~~~ ~ ~~ D <br />Permit No: Southwest Properties <br />FEg 1 1988 <br />Operation Name: M-~81-158 <br />Anniversary Date Forest Lakes Pit #1 MINEDLgNp <br />b1 /26lD8 RECLAMATION DIV1glON <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 ~clamation <br />Division for annual fees due (4 ` <br />Annual Report <br />Remarks: <br /> <br />~ f ~~ ~.,,~'. ~i.t ~.~.2 ~ ~ f~~~ ~R w', t l 6~ ~ ,~ ~ ~ <br />(Rev. 02/87) <br />5257E <br />~1 <br />