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• iii iiiiiiiiiiiu iii • • <br />• 999 <br />' ~ ~ ~ - /~1 e~,osure <br />Permittee Name: Jake Kauffman & Sons, Inc. lAR z3 139 <br />Permit No: M-78-327 0 <br />Operation Name: Kaufman Pit b11N <br />Anniversar Date: 05/14/9. 3ECr ~,qp ~~I-ANC <br />y AT! n~ ..,,... <br />Total: ~ ~.~1,Q,. (Due on the Anniversary Date) ~; <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 REPORT: <br />6l --F.2 <br />~ ~, <br /> <br />~-~~, ~~~~~ c~ h_c~:P <br />~m ~ ~ ~~ 2 ~Q1CS-_c~-~ . <br />~ X92, ~ i ~-c~u~ cG ~~I~ ~~ I~ a u~e _ ~,gc,~~,-,'~. <br />~~-i,~.rv o~ ~r~d I,u-e, Cam c1 o c~brs~t <br />~~ . <br />~ r -~, <br />Signature <br />[~~ya~ <br />