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<br /> <br />.. <br />Permi ttee Name: <br />Permit No: <br />Operation Name: <br />Anniversary Date <br />Farnsworth Construction Co <br />M-82-154 <br />Farnsworth Gr Pit 2 <br />11/05/89 <br /> <br />®~ ~ ~ d bp„cl os ur e <br />Nav l~ t~~~ <br />MINED LAivp <br />RECLQ,MATION J1v1510w <br />Please return this form Y+ith your completed Annual Report and a check or <br />money order for annual fees due, payable to the Colorado Mined Land Reclamation <br />Division, 1313 Sherman Street, Room 215, Denver, Colorado 80203, <br />ANNUAL REPORT: <br />~a-a~~a~, VJ~ <br />~,uJ <br />~ ~~i ire .d-~ ~ ~~~~~~~° ~j ~~`~~~ ~~J~ <br />o ~~ <br />MINE <br />RECEIVED ,~ <br />I ~ FROMM-- <br />i <br />~~ FOR 12l2'L~ <br />AMOUM OF <br />1313 Sherman, Room 215 <br />Denver, Colorado 80203 <br />(303) 866-3567 <br />an,,n,pA,) D~~ <br />(~ <br />~' CC <br />OUNT...... ....$ O• <br />AMOUM PAID ...................5 <br />BALANCE DUE ...................$ <br />QVl~2 OU ~ <br />BY <br />~ilT -wow <br />Signatur`eyYJr~~-o~ <br />U ~i~L1 <br />__ , <br />N °_ 0112 6p6q <br />DATE ~ ~ - I.3 19 0 / <br />S~CFiECK <br />^ M.O. <br />