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iii iiiiiiiiiiiiiiii <br />999 <br />• 111/112 Enclosure <br />Permittee Name: Hazeltine Invest Inc R E C E I VE p <br />Permit No: M-77-153 <br />Operation Name: Reclamation Pit No 1 APR 0 ? 1987 <br />Anniversary Date: 02 / 07 / 87 <br />RECLAMATION DI~ISION <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check cpace(sl belowl <br />Check or money order payable to Colorado Mined Land Reclamation <br />Division for annual fees due <br />Annual Report ~o ~\~p`~ ~ c. ~c~~1 ~~ <br />Map <br />Remarks: <br />Signature <br />~(7~~7 <br />