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.~'• <br />I~~ I~III"~"I~"I' <br />:~ `y, <br />Permit No: 79-103 <br />Anniversary Date: April 8 <br />Operator: Bailey Construction Company <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check box(es)) <br />Check or money order payable to the Colorado Mined Land <br />_ Reclamation Division for annual fees due <br />Annual Report <br />Remarks: <br />car <br /> <br />RE~~~~~~ <br />P.!'' ~ ~:. , , <br />~~. <br />:~. <br />n4ND R~C/i a~,..q ~~04+ Dw15'10!1 <br />~'''"~ kesowces <br />