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<br />• ~II ~I~~II~I~~~~~ ~I~ <br />sss <br />Permittee Name: Ron Ebberts <br />Operation Name: <br />Permit No: 80-38 <br />Anniversary Date: October 1 <br />110 and 111 Attachment <br />C' <br />RECEIVED ~~ <br />DEC 7 1984 <br />MINED LAND RECLAMATION DIVISION <br />Coto. Dept of Natural Resources <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check box(es)) <br />I_I Check or money order payable to Colorado Mined Land <br />Reclamation Division for annual fees due <br />~-~ Annual Report <br />Remarks: ~ ,7~,,,Q,,.~ <br />s; <br />(Rev. 5/84) <br />Doc. No. 1782 <br />~~ ~ <br />~. <br />r~ ~ <br />