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<br />Permittee Name: <br />Permit No: <br />Operation Name: <br />Anniversary Date <br />Dotsero Block, Inc. <br />M-87-074 <br />Dotsero Quarry <br />10/09/88 <br />n <br />u <br />111/112 Enclosure <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 <br />_~ Map <br />Remarks: <br />Signature <br />(06/88) <br />0054f <br />