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~ ll Illlllllllllllll ~ <br />I 999 <br />Permittee Name: Farnsworth Const ' <br />Permit No: M_gp_154 <br />Operation Name: Farnsworth Gr Pit 2 <br />Anniversary Date: 11!05/87 <br />.~ <br />~' - - <br />~ r I'_ ~ ~ .._ .. <br />Nl tl1 -\-. _.. . <br />NOV 91981 <br />t~~1h1~D LAP'C <br />tiECL6afJIA-i lOf~ Dfli1S:C~`~ <br />110 Enclosure <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />,E,nc/losed are: (Check space(s) below) <br />'1( Check or money order payable to Colorado Mined Land Reclamation <br />-7"°- Division for annual fees due <br />Annual Report <br />Remarks: <br />Signature <br />(Rev. 02/87) <br />5257E <br />lam"' ~ <br />