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<br />112 Attachment <br />Permittee Name: Asphalt Gravel Prnriurtc Tnr <br />Operation Name: ~lyw,{/-,~,,/ <br /> <br />RECEIVED <br />OCT 2J 19A~1 <br />Permit No: 78-271 MINED LAND RECLAMATION DIVISION <br />Anniversary Date: October 30 Colo. Dept. of Natural Resources <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check box(es)) <br />~I Check or money order payable to Colorado Mined Land <br />Reclamation Division for annual fees due AC-Pr~~- JoJ~ <br />' I-I Annual Report <br />i-I Map <br />Remarks: (~D_n.e~-.L a.,tec. ~-,-~ati~ n.e..~~,, ; ~~ <br />Signature <br />(Rev. 5/84) <br />Doc. No. 1805 <br />~, <br />~; IQ <br />