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<br />111/112 Enclosure <br />Permittee Name: Fremont Paving Inc <br />Permit No: M-80-224 <br />Operation Name: McKenzie Pit <br />Anniversary Date:10 / 27 j 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 / U ~C~-~J cr~~ ! S ~~ <br />Map 7 9 «., js {y~+--~/~ <br />Remarks: <br />~~~.~. __ <br />M~ "moo <br />r <br />t <br />Sivnature <br />