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. <br />• ~ ~ - - • iii iiiiiiiiiiiuiii <br />999 <br />112 Enclosure <br />Permittee Name: Broderick & Gibbons <br />Permit No: M-81-307- <br />Operation Name: FOUNTAIN PIT <br />Anniversary Date: 12 / 03 / 85 <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 />pECE1VEt~ <br />~_ Annual Report <br />DEC i a 19K <br />Map _ <br />/ C01~. Dept. M MaRW~ta~ R/IIOUTION/ / <br />Remarks: ~ Ye~.~drrtca7ioH ~t4.5 Nor Can .D~ dor,~ aT <br />Signature <br />ral~3lg.f <br />~^ -~ ~~- <br />~` (~ <br />i ! / /' / r <br />