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t> M?- <br />M-X980-,2y8?AM?6z? <br />MOFFAT COUNTY CLERK AND RECORDER <br />221 W. Victory Way <br />rtleO Craig, CO 81625 <br />p ?R 0 5 2010 <br />of RdCla+??Ow, (970) 824-9104 <br />pivV,n and SsxfetY <br />MINING/ RECLAMATION FORM <br />File Number / 2- l1 ?` ?O <br />°2 <br />N <br />i r&. MAR 2 9 2010 <br />v ND i ?j uFFiCE <br />kJ3V?:''' . :.9 ;F <br />SAFFTY <br />Drawer Number <br />Return Date D <br />c?p <br />Received From_ <br />Mailing Address <br />C?2(/ l d <br />- <br />Cr??' `l/lJ <br />Mining and Recla ation App ication for. <br />Name of Pit or mine: O?Z <br />Date on which inspection period is over and application may be retrieved by <br />Applicant: <br />Agent Signature: <br />' For: <br />Q? <br />row icRS <br />Attest: County Clerk or Deputy: <br />/}'Icy. mom