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'-.~ -~ <br />,. <br />Permittee Name: <br />Permit No:' <br />Operation Name: <br />Anniversary Date <br />111/112 Enclosure <br />;fit . <br />Bar 70 Enterprises~~Ve-^• ~ `• <br />M-77-132 <br />Berry Ptt JAN 3 01987 <br />O1 /16/97 <br />Mi~i~_ <br />gECLAMATi _ : .- <br />Please complete the following and return this.form with your fees and <br />reclamation data. <br />Enclosed are:. (Check space(s) below) <br />x Check or money order pgyabie to Colorado Mined Land Reclamation <br />Division for annual fees . <br />Annual Report <br />Map <br />Remarks: Annual Report and P1ap will be mailed within 15 days. <br /> <br />gnature <br />°~• ~' ~ <br />~r ~G <br />