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MOFFAT COUNTY CLERK AND RECORDER <br />221 W. Victory Way <br />Craig, CO 81625 <br />(970) 824-9104 <br />RFc✓GNc 40 <br />MINING/ RECLAMATION FORM 4%•, 6,r & <br />ti� <br />c�sq�� F <br />File Number <br />Drawer Number. <br />Return <br />Mailing Address <br />Mining and Reclamation Application for: <br />Name of Pit or mine: <br />Date on which inspection period iMOP r 'pp cation <br />Applicant: nlm. �y aza:f= <br />q�/ <br />be retrieved by <br />Agent Signature�.��`'~� <br />For: 0—o.✓ ;,-.jT rJC QS <br />Attest: County Clerk or Deputy: <br />