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1 . <br />Permittee Name: <br />Permit No: <br />. III Illllllllfllllll <br />Nielsons, Inc. <br />M-76-059 <br /> <br />111/112 Enclosure <br />RECE~ VED <br />Operation Name: Cortez Pit JUN 201988 <br />Anniversary Date: 06/17/88 <br />MINED LAND <br />RECLgMgTfON Df 1SION <br />Please complete the following and return this form with your fees an~ <br />reclamation data. <br />Enctl~osed are: (Check space(s) below) <br />/r Check or money order payable to Colorado Mined Land Reclamation <br />Division for annual fees due <br />/` Annual Report <br />/ Map <br />Remarks: <br /> <br />Signature <br />(Rev. 02/88) <br />5257E <br />0054f <br /> <br />