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J <br />• III III IIIIII IIII'll • <br />999 <br />ty C p~ ~ ~ ~~1~Enc1 osure <br />Permittee Name: <br />Permit No: <br />Operation Name: <br />Anniversary Date <br />Caldwell Brothers <br />M-86-016 <br />Caldwell Brothers 3 <br />06/01/89 <br />JUL 181989 <br />RECt MfATIp-y Ot~l~f~i4 <br />Please return this form with .your completed Annual Report, map, and a <br />check or money order for annual fees due, payable to the Colorado Mined land <br />Reclamation Division, 1313 Sherman Street, Room 215, Denver, Colorado 80203. <br />-ANNUAL REfOR~: <br /> <br />.~ <br /> <br />~~ <br />Signature <br />