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Gate of Service <br /> ------------ 19--- "! INED LAND R E C L A u A T JON _ ISI7., <br /> Person <br /> --------------------- �Y----��-� <br /> Doug_Bo_w_m_a_n_Env. Coordinator ( euthoriLed representative ) <br /> ( Pleas? orint name and title ) ----- <br /> Sianatire Dan Mathews, Reclamation Specialist <br /> --------------=---------- <br /> ( P4r5on served) ------ _ <br /> -------------------- <br /> (NaTe and title - please print )---- <br /> IMOOPTA:4T: PLEASE REPO THE ;EVERSE SIDE OF THIS PAGE . <br /> 10/79 C -R - 3- 1373, 34-33- 123 <br /> E <br />