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~ , ~ , • ~~ <br />III IIIIIIIIIIIIIIII <br />R 110 Enclosure <br />Permittee Name: Jim Helmericks SFP $ @1981 <br />Permit No: M-85-001 <br />Operation Name: J & J Pit MINED LAND ~ <br />Anniversary Date: 06~P7/87 RECLAMATIONDfVIS10N <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check space(s) below) ~ <br />Xxxxx Check or money order payable to Colorado Mined Land f~eclamation <br />flivision for annual fees due <br />xXxxxx Annual Report <br /> <br />Remarks: <br />Signature BURN <br />Vice <br />(Rev. 02/87) <br />5257E <br />sident <br />