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~ III IIIIIIIIIIIIIIII ~ <br />999 <br />110 and 111 Enclosure <br />Permittee Name: <br />Ron Ebberts ~~~~~tl <br />Permit No: M-80-038 <br />Operation Name: Disappointment Valle NOy 1 <br />Anniversary Date: 10/01/86 y 19~'y <br />R~C~gM~ly~p Cq <br />~! l~0 NO <br />Please complete the following and return this form with your fees and ~ Q~~~.S'Ifjp, <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 />Remarks: <br />~~-, ~~.~ <br />Signature <br />t=, • (e <br />N ¢ Q~ ( j C. ~s'(Fc'~ <br />