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<br /> <br />Permit No: 82-15 <br />Anniversary Date: December 10 <br />Operator: <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check box(es)) <br />Check or money order payable to Colorado Mined Land <br />_ Reclamation Division for annual fees due <br />~~ Annual Report <br />`~ Map <br />Remarks .1; c' r'•4~ ,:'~S ,~,,ii 1~~~c_c':~~;? s~,~.r~ 7;~;.:~~ <br /> <br />//'~( /1/'°~~' i~/r% rim/~iC,[ r "iy%'~Jr„- <br />~/. <br /> <br />Si <br />