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• <br />Permittee Name: <br />Permit No: <br />Operation Name: <br />Anniversary Date: <br />AFR 18 1989 <br />Darryl D. Stout <br />M-79-103 MINtC LAND <br />Amick ~ECI-AMA71ON DIVISitDN <br />04/08/89 <br />iii iiiiiiiiiiiii iii <br />110 Enclosure <br />Please return this form with your completed Annual Report and a check or <br />money order for annual fees due, payable to the Colorado Mined Land Reclamation <br />Division, 1313 Sherman Street, Room 215, Denver, Colorado 80203. <br />ANNUAL REPORT: <br />/~-j ~y- /J~%z Leu ~~ /yll.Iinp ~1~-.. ~ ~~~ <br />(.~~, <br />Signatur <br />