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<br />Permit No: 80-3 <br />Rani versar_~ Date: Jd/lUd ry <br />• RECEIVED jjGGII <br />Y <br />JAN 211983 ~'" <br />MINED LAND RECLAMA71ON <br />COLO. DEF7. OF NATURAL RESOURCES <br />ooerator: <br />PZease complete the following and return this form with your fees and reclamation <br />data . <br />Enclosed are: (Check box(es)) <br />Check or money order papable to Colorado l9ined Lard <br />~~~--------lll,,, Reclamation Division zor annual fees due <br />Annual Report <br />Remarks <br />U .- <br />Signed, L <br />Q <br />~~~ <br />