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112 Attachment <br /> Permittee Name: Ideal Basic Industries, Ino. <br /> Operation Name : Boettcher Limestone Quarry <br /> Permit No : 77—W <br /> Anniversary Date: October 10, 1986 <br /> Please complete the following and return this form with your fees and <br /> reclamation data. <br /> Enclosed are : (Check box(es) ) <br /> ICI Check or money order payable to Colorado Mined Land <br /> Reclamation Division for annual fees due <br /> $350.00 <br /> ICI Annual Report <br /> Igl Map <br /> Remarks: r10n�9/�/n <br /> Signature Paul E. Tiomsen <br /> (Rev. 5/84) <br /> Doc. No. 1805 <br />