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RECLUVE3 <br /> Permit No: 78-208 ,UL I 1983 <br /> Anniversary Date: June 16 <br /> MINED LAND RECLAMATION <br /> Colo. Dent. Of Natural Resources <br /> Operator: <br /> Please complete the following and return this form with your fees and <br /> reclamation data. <br /> Enclosed are: (Check Dox(es) ) <br /> 1f- Check or money order payable to Colorado Mined Land <br /> Reclamation Division for annual fees due <br /> Annual Report <br /> Remarks: At44 ,1?- % u <br /> T <br /> Signature <br />