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._ <br />111/112 Enclosure <br />ncr r~~ ~ssr <br />Permittee Name: M 78 116orp ~tCLAMATiON D~ISION <br />Permit No: <br />Operation Name: Sm-18 Mine <br />Anniversary Datef0/30/87 <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 />Signature <br />(Rev. 02/87) <br />5257E <br />