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_ iiiiiiiiiiiiiiiiiii <br />110 and 111 Enclosure <br />Robert Gerner / <br />Permittee Name: M-81-108- ~1~~„ f ~/.'3 ~" <br />Permit No: Pablo Vasquez Stone ~--~~ ~%~ <br />Operation Name: 08 / 29 / 86 f7-, G ~^-~- <br />Anniversary Date: <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 />f/ Annual Report <br />~r',r4 r"'i~^. -rte <br />".':~ .~ _ <br />i. <br />SEP i b i9s6 <br /> <br />Sig <br />~/~~/CSC <br />~ ~-, <br />ji (e <br />