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~ iii iiiiiiiiiiiiiiii ~ ~~ <br />._ ,~~ <br />112 Enclosure <br />Permittee Name: Charles J Webster <br />Permit No: M-81-235- <br />Operation Name: West Tennessee ~1a11~~1;;6~ <br />Anniversary Date: 04 / 22 / 85 <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 />1~ Annual Report <br />Map <br />0 <br />Signature <br />