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ti <br /> <br />Permittee Name: Darryl D Stout <br />Permit No: M-79-103- <br />Operation Name: AMICK <br />Anniversary Date: 04 / 08 / 85 <br />~IIII~II~II~II~~III <br />ff ~~ ~r~C~ 110 and 111 Enclosure <br />l('A~m~ <br />!UN 2 41985 <br />MINED LAND <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 />__~__ Check or money order payable to Colorado Mined <br />Land Reclamation Division for annual fees due <br />___~__ Annual Report <br />Remarks: <br />gnat <br />