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<br />Permittee Name: Siegrist Const Co <br />Permit No: M-82-015 <br />111/]12 Enc]osure <br /> <br />Operation Name: Siegrist Const Co FE B 0 3 1987 <br />Anniversary Date: 12 / 10 / 86 <br />MINED LANQ <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 />x Check or money order payable to Colorado Mined Land Reclamation <br />Division for annual fees due <br />x Annual Report <br />Map <br />Remarks: See letter dated January 16, 1987 <br /> <br />Signature Robert. 5' rist, President <br />SIEGRIST C NSTRUCTION CO. <br />