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<br /> <br /> <br /> <br /> <br />110 and 111 Enclosure <br />Permittee Name: <br />Permit No: <br />Operation Name: <br />Anniversary Date <br />F & K Holsinger <br />M-80-052- <br />HOLSINGER GRAVEL PIT <br />04/23/86 <br />Please complete the following and return this form with your fees and <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 />Signature <br />