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i III IIIIIIIIIIIIIIII • <br />111/112 Enclosure <br />Permittee Name: ~ ~~~ ~ ~~ <br />Permit No: Jake Kauffman & Sons <br />Operation Name: M-78-327 MAY 15 198] <br />Anniversary Date: Kauffman Pit <br />05/14/87 MINED LANll <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 Land Reclamation <br />Division for annual fees due <br />Annual Report <br />Map ,... _ .,, <br />Remarks: ~s~._~.~"2A(`tocC ~fl(L, ~G~~n ~-h(1Cl ko[~ (~(1 YY11tl, f)l~Q7A~ <br />(1('120 „ I ~~Q , I l_N~U_~(~ ~ (' i 1(~ ~ ~t~ ~-tY~[~1CQ, Ca `n~5~o . +-R~nt <br />~ fh Q , ~ 1~ o orb .n C eZ r~~c0 ' ~,e. IQ~15 (`~,'l,~c.4 h«r9 ~ ~ (Ir.OSi~OJ~~ iaA, <br />U D °lo ~~itRt C`,ct 1~G , ~a ~ . ~~a , .~'1 G c~.m o , ~ -k ~ i o , ~ ~Bl ~ ~i1('`ITfla <br />1~4C~nc~ c~ Sic{ ~~ic . c~u_~?. ~' 1} ~ n rn~ .~r~Q ,. <br />R~~rl~ ~lE - - <br />Signature <br />(Rev. 02/87) <br />5257E <br />51~s ~~ <br />~l4 . <br />~•~ e <br />