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<br />~ iii iiiiiiiiuiiiiii <br />110 and 111 Enclosure <br />Permittee Name: Charles Devereaux <br />Permit No: M-78-221- <br />Operation Name: K-BAR-T PIT <br />Anniversary Date: 08 / 23 / 85 <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 for annual fees due <br />Annual Report <br />Signature <br />• {~ ~ ,~ <br />AU6 2 G i98 <br />ti;i~E~ ~:~:v~ <br />ocri nnaaTinti nivicinni <br />