Signature Office / Red Cross / office of Mined Land Reclamation Accepted / SAFETY Department of Natural Resources / DIVISION of RECLAMATION MINING / Durango office of Active / Durango Title Date office of Active and Inactive Mines / STATE OF COLORI\DO DIVISION OF RECLAMATION / COLORADO DIVISION OF RECLAMATION / / /
Position
Electrical Supervisor / Driver / Qualified Company Electrical Official / /
STATE OF COLORADO DIVISION OF RECLAMATION, MINING AND SAFETY Department of Natural Resources 1313 Sherman St., Room 215 Denver, Colorado 80203