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~a <br />• <br />Permit No: 81-75 <br />ri_~; . <br />Anniversary Date: _ ,1„~y 3~ ~"'~-°~~~~'--,tad <br />~' ' ; 1 i 1982 <br />Operator: 1~„ <br />~ . C t, Lft^~'~ kkCLAM.~1 i lON <br />Please complete the following and return this form rrr'fth~yourJlfees~;~rta,secZtamation <br />S~L~l, <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 />A»nual Report <br />Signed, <br />OM -~" <br />o~~~~i <br />