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File Number <br />MOFFAT COUNTY CLERK AND RECORDER <br />Drawer Number 7 . 2_4- <br />Return Date CO /\ /1Q20 s <br />221 W. Victory Way <br />Craig, CO 81625 <br />(970) 824 -9104 <br />MINING /RECLAMATION FORM <br />Agent Signature: <br />For: 1-/I &e4 <br />r <br />Attest: County Clerk or Deputy. . � <br />RECEIVE <br />GR ` 'JU L 2 0 2011 <br />AND <br />JUNCT,i0 <br />13 t, p REC <br />DIVIgICry O OFFICE <br />�MATION MIlV�Ir,I(; SAFETY <br />RECEIV60 <br />JUL 22 2011 <br />uivision of Reclamation, <br />Mining and Safety <br />Date - 711 c t / 2 0 1 / <br />Received From M, A f? A/ MO OR LOL) n "l r--n v S <br />Mailing Address Z 2° i a C- A_( 1/1/4 <br />C___sfl 0 .12 <br />Mining and Reclamation Application for: <br />Name of Pit or mine: 1---1/./1 ) r bp l t t f <br />/Date on which inspection period is over and application may be retrieved by <br />vi Applicant: ?L� _:; f J f t C 0711 2 t. 1 <br />t t 5S( CO <br />