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<br />Permit No: 79-131 <br />Anniversary Date: July 27 <br />Operator: <br />Please complete the followin~and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check box(es)) <br />Check or money order payable to Colorado Mined Land <br />Reclamation Division for annual fees due <br />Annual Report <br />RECEIVED <br />Siynature <br />h (I~ ~~ <br />Orr -~° <br />SEP 1 ~ 1983 <br />MINED LAND RECLAMATION DIVISION <br />Colo. Dept. of Natural Resources <br />` lG <br />~~ <br />