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<br />111/112 Enclosure <br />Siegrist Const Co rz <br />Permittee Name: M-82-015 ~ ~ ~'~ ~__ <br />Permit No: Siegrist Const Co <br />Operation Name: 12/10/87 ~ ~ ~ 1 <br />Anniversary Date: <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 <br />X Annual Report <br />x Map <br />Remarks: (Please see attached letter) <br />Signature Robert L. Si s President <br />SIEGRIST CON UCTION CO. <br />(Rev. 02/87) <br />5257E <br />