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• iii iiiiiiiiiiiiiiu ~ <br />;~ <br />~ ~. r'nl r•~ n~Sn~' A <br />FY lS~ ? as ~:., <br />112 Enclosure <br />M.4R 2 01986 <br />Permittee Name: Hazeltine Invest Inc <br />Permit No: M-77-153- ~,~t~:; id ~~9ti:dt s+t_w~:!t45ia~ii~i~ <br />Operation Name: RECLAMATION PIT NO 1 Coiu.Oupt. ui'i'=3aa'a! Resources <br />Anniversary Date: 02 / 07 / 86 <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check space(s) below) <br />Check or money order payable to Colorado Mined Land Reclamation <br />Division for annual fees due <br />_~ Annual Report <br />Map <br />Remarks: <br /> <br />Sig <br />