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-- <br /> <br />~~ 112 Enclosure <br />...~ .~. <br />Permittee Name: N Colo Water Conserv <br />Permit No: M-81-086- ,I.11 ~ 5 <br />Operation Name: BORROW AREA C <br />Anniversar Date: 07 / 21 / 85 p,.;~pd~p LAND <br />Y -, ~ ~ r~ <br />CiE~L".~7~RTIOt~ x.1.1:,1• '~ <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check space(s) below) <br />X Check or money order payable to Colorado Mined Land Reclamation <br />Division for annual fees due ~j A ,/~ <br />Annual Report "~ ~~On-7 <br />- ~ C/ <br />V' <br />Map (~ <br />Remarks: Check enclosed. Annual Report and map to follow. <br />Signature <br />