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-~- . • <br />Permittee Name: Nielsons, Inc. <br />Operation Name: rnrta~ Sanrlcrnna p;r <br />Permit No: 76-59 <br />Anniversary Date: June 17 <br />iiiuiiiiiiiiiaiii <br />112 Attachment <br />Operator: <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: {Check box(es)) <br />I~ <br />I~I <br />I!I <br />Check or money order payable to Colorado Mined Land <br />Reclamation Division for annual fees due <br />Annual Report <br />Map <br />Remarks: ANNUAL REPORT & MAP TO FOLLOkI UNDER SE1?ARATE CODER. <br />i <br />-ai/- a <br />~ •:-. <br />~~ <br />1<: _ .- <br />Signature / Douglas L.UConger <br />Engineering Geologist <br />(Rev. 5184) <br />Doc. No. 1805 <br />cc: Cortez Pit, Engr.(2) <br />6t~ s'I s ~ <br />G}'N <br />~` f'~ < <br />r <br />~~ <br />a-., ~ ~ <br />~uN • ~~ i~a4 <br />..-ssff"N <br />