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• <br />Permit No: SO-249 <br />Anniversary Date: February <br />~ iii iiiiiiiiiiiiiiii <br />RACE'\~'D <br />EEB 1 ' ~cc~ <br />Operator: ~~D UND Rea<••~~~-°~ <br />LCOtA, DEPT. of w.,__... -Es <br />Please complete the following and return this form with your fees and reclamation <br />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 />Remarks <br />Signed, ~~~~~Z~ `~/(/ /`l~Z~r1, <br />~~ (~'~ ~3 <br />• ~~ 0 <br />RECEIVED <br />FEB 171983 <br />MINED LAND RECLAMATION <br />COLO. DEP t. OF NATURAL RESOURCES <br />a~~~ <br />