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. <br />Permittee Name: Ron Ebberts <br />Permit No: M-80-038- <br />Operation Name: DISAPPOINTMENT VALLE <br />Anniversary Date: 10 / O1 / 85 <br />110 and 111 Enclosure <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />--Enclosed are: (Cf-ieck'speceTs)~belowT <br />Check or money order payable to Colorado Mined Land Reclamation <br />Division for annual fees due <br />Annual Report <br />Remarks: <br />:jj <br />., <br />'~w,~... ~ e. <br />•.;;. <br />~~h`5~a,,~~~/ <br />Signature <br />i ~. /a,/ 8',f <br />9)1, s~• 0 <br />~~ /e. a <br />~- <br />