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~ III IIIIIIIIIIIIIIII <br />112 Enclosure <br />Permittee Name: Clayton Construction Company <br />Permit No: 79-187 C-~~ 3`~ ~`~~ <br />Operation Name: /~~~~ <br />Anniversary Date: January 23 ,~ _~ ~~ <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 />Map <br />Remarks: <br />gnature <br />