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<br />111/112 Enclosure <br />Permittee Name: Rerad~~r Mixed ConGr'e+e Go. ~GV~~~~~ <br />Perini t No: 77- 4 310 <br />Operation Name: ToHler Pt t PEAR 91988 <br />Anniversary Date: A,u.c)u>~ 2$ <br />MINED LAND <br />RECLAMATION DIVISION <br />Please complete the following and return this forth with your fees and <br />reclamation data. <br />Enclosed are: (Check spe~ce(s) below) <br />~_ Check or money order payable to Colorado Mined Land Reclamation <br />Division for annual fees due <br />~_ Annual Report <br />~(_ Map <br />Remarks: <br />r• J ~ 2~~ <br />Signat re ~~,~/ r _T ~ <br />`~L'! ~~ ~ ~~ Kl~YId~ ~ ~i~ . <br />~ (Rev. 02!87) ~`~ <br />5257E <br />