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112 Enclosure <br /> Permittee Name: General Refact Co <br /> Permit No: M-77-219- <br /> Operation Name: BEULAN MINE <br /> Anniversary Date: 03 / 22 / 86 <br /> Please complete the following and return this form with your fees an <br />_ reclamation data. 1".R <br /> Enclosed are: (Check space(s) below) <br /> Check or money order payable to Colorado Mined <br /> Land Reclamation Division for annual fees due <br /> Annual Report <br /> Map <br /> Remarks: <br /> y Src� Z Q. .�vvc <br /> i <br /> �n. /� �Ya�-s-.�-T`�.-� e ./,�//i Td a'�/- 7r sl��ct� gL�d .-rf�l�s•. <br /> it 19�G <br /> e- <br /> Si nature � - <br /> hAsi •t+ <br />