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<br />7 <br />Permittee Named-y y <br />Permit No: <br />Operation Name: <br />Anniversary Date: <br />~~ a <br />APR 1 1 1988 <br />Darryl D. Stout <br />M-79-103 Aeia~E' <~`il~~: <br />Amick ~ECl1;.~,4t~plt.i;•~ t7fYt3Z,trd <br />04/08/88 <br />1111111111111111111 <br />110 Enclosure <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check space(s) below) <br />_~ Check or money order payable to Colorado Mined Land Reclamation <br />Division for annual fees due <br />~_ Annual Report <br />Remarks: <br />13) 7'Ae .l,o,v1 ~ /ice ~~j2 lyAst c,1. c.,~.,F'~..~~,u <br />G~, ~~ .~.wl A..6~t 6on.t1 C.eC/ASS,`.l v <br />Signaturd <br />7286G <br />0052f <br />