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,~ <br /> <br />~ ~II II~II~II~II~~ ~I~ <br />99y 110 Enclosure <br />Perini ttee Name : W u y ~ r P ~ ~ ~Y°s F // o ~ ~~ ~u s ''pp <br />r, a ~ l ) <br />1 , <br />Permit No: M-S's - ~ 10 <br />Operation Name: R ~ ~ k.~ /~ ° °- 1 Q <br />' <br />Anniversary Date: q~. _ ~ - ~ <br />~ <br /> ~5~ ~ ~?~~ . 7 y <br /> <br />Please complete the following and return this form wi th yo ~~ ~ ~~ <br />reclamation data. <br /> FEB 111988 <br />Enclosed are: (Check space(s) below) MINEdLAND <br /> REC MATION aIVISiOF <br />/ <br />d Check or money order payable to Colorado M ined Lan Reclamation <br />Division for annual fees due <br />/ Annual Report <br /> <br />Remarks: /~ r~PC ti~ Pd r ~ ac/c <br />~ <br />~ <br />d <br />,~ ~ <br />/ / <br />A ~~ i ~ ~ r ti <br />' <br />a <br />y <br />~1 S f ~ .~ a <br />LL <br />~ <br />' <br />- <br />~ / <br />l <br />P ~ / <br />/ <br />7 <br />/ V P/ , <br />J` f ~ iJ / S / ~P/ s i° h <br />` <br />~ <br />~ lnI ~ <br />O <br />s <br />/ <br />v+.1 H o 1 /; <br /> <br /> <br /> <br />~ ~ <br />S , J n ! f At, <br />~~ <br />' ` <br />~ <br />~/ <br />/d , <br />AM <br />/ Q <br />0 [vH <br />r, b/1 <br />I <br />`'L <br />p wnr ON pO~ •.y /`PC ~p n l~~~an ~ ~e <br />rrlP ~~/l <br />/`o,QP/' ~ ~ <br />Signatur <br />(Rev. 02/87) <br />5257E <br />9~ <br />urn S <br />(IUD H f <br />~9i), <br /> <br />V v <br />