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~•M,' <br />•~ III IIIIIIIIIIIIIIII <br />110 and 111 Enclosure <br />Permittee Name: Raul Vasquez l~~ "1 q 5 V <br />Permit No: M-81-107- <br />Operation Name: BEECH HILL QUARRIES ~Jr-"D, Q(~ <br />Anniversary Date01 / OS / 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 />Remarks: ~„+/~ [;v{ Sl.l( m, N•n% j j j y ~T1 /~ ~hf.ju'4`~_ <br />j t vY 11 ~~~~ r e F~; > rh ~ r yam. ~c/~ r~, C <br />r <br />~t~-canT n ~ ~~~ C~Ua~r %{SF <br />~~ <br />Signature <br />