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-~ v • • III IIIIIIIIIIIII III <br />999 <br />110 Enclosure <br />Permittee Name: R G ~ ` ' ~ ~ D <br />Permit No: Darryl D Stout <br />Operation Name: M-79-103 MAY 0 1 1987 <br />Anniversary Date:• Amick <br />04/08/87 MINED LAND <br />RECLAMATION DIVISION <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 rot annual fees due <br />,~ Annual Report <br />Remarks: <br />;~ <br />(Rev. 02/87) <br />5257E <br />5/~~~7 <br />~.~ ~ <br />~; (e <br />