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MINED LAND R. .AMATION DIVISION Np ~-t~867 <br />1313 Sherman, Rm. 215 <br />Denver, ColoraQo_ 80103 Dare 2 ' ~~ t 9 ~ ~ <br />(303) 866-SSE <br />RECEIVED I / ._ _ $ 12 /~ <br />FROM /1 ~'~LG V <br /> <br />^ CA$H <br />'13CHECK <br />^ M.D. <br />AMOUNT OF SiCCDUNT...........$ /`~'N' II <br />AMOUNT PAID.. ... ~ `~+ U I <br />BALANCE OUE ... .. ............$ BY <br />rate for report year on back <br />5. The type and approximate quantity of fertilizers, organic material or soil <br />conditioners used for the report year:* N/A <br />6. Estimated total acres to be affected in the next report year:* .5 <br />7. COP'AdENTS: ACREAGE IS ESTIMATED <br />* Ple,ise show the location of the acreage for items 2 - 6 on your map**. <br />Indicate the phases of the reclamation which have been completed, correlated <br />with your timetable. <br />NOTE: If there have not been any changes since the last annual report and <br />you previously submitted a map which correctly depicts the current acreage in <br />items ? through 6, then a new maD is unnecessary. However, you must state this <br />fact above. <br />Signature: Date: 2-21-91 <br />Please ty or print current contact name, address, and phone number below: <br />Contact Name: JoHx F. CARDER Phone: ( 719 ) 336-3479 <br />Address: P.O. Box 721 / <br />LAMAR, CO 81052 ,// <br />1 r Jl/~Ao\ <br />~OV~ <br />r~~ <br />