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1 ~~ <br />~ i <br />Permit No: 81-228 <br />Anniversary Date: November 13 <br />Operator: <br />Please complete the following and return this form with your fees anc <br />reclamation data. <br />Enclosed are: (Check box(es)) <br />Check or money order payable to the Colorado Mined Land <br />Reclamation Division for annual fees due <br />Annual Report <br />~ Remarks: GAaO /t-~/ti~0 P/zEd/O~JS Y~-/Zr 3 Ac2,ES , <br />/ .9r/o To S~ .tii.~c o ~t/E K r vEA2. /D ~¢a /2 B5 . <br />Pfi~.G7/~c. ~F.CG.9/~`~'~O~ ~ffaC7LA TAKE ~°c.~cE <br />/.t/ /9 ~y <br />C~~~~~~,`~D <br />p.ia~~ ~ g 1983 <br />i.11NED IL,p!O ficC!R^1ATION DIVISION <br />Calo. Uepi. of wa,ural Resources <br />tr /as /~s <br />~'YL . ~. <br />I <br />