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110 and 111 Enclosure <br /> Permittee Name: Russell D Neesham <br /> Permit No: M-77-500-UG <br /> Operation Name: PEGGIE MINES <br /> Anniversary Date: 06 / 29 / 85 <br /> Please complete the following and return this form with your fees ani <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 /> Remarks: <br /> /7Jj )sr) u/25- / ol1z,/4c IJrel/fdlls/� /./ <br /> //(''�•. � y Quo Yl4 / -e�L,P�1' 4/7U �/n.s cY 7d 62 Q��� •ea' f :S {�� <br /> ICE ) J7d �Q �a/irt 1 eci> �� r�r4�cpr�fi � <br /> i <br /> Signature <br />