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<br />110 and 111 Attachment <br />Permittee Name: Earl L. Hale <br />Operation Name: HALE PIT <br />Permit No: 81-121 <br />Anniversary Date: July 23 <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check box(es)) <br />'~a~~ Check or money order payable to Colorado Mined Land <br />Reclamation Division for annual fees due <br />I_I Annual Report <br />Remarks: <br />- ~~c~C _I r7~vC.t~- <br />Signature <br />(Rev. 5/84) <br />Doc. No. 1782 <br />