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<br /> <br /> <br /> <br />~ ~g~` <br />112 Enclosure <br /> ~ ~. <br />9 ~T~. ,, . ~.. <br />' ~ s--~ <br />Permittee Name: Denver Brick Co a L ..J <br />Permit No: M-77-392- <br />Operation Name: Dawson State Lease r~jftj~ I v ;~ <br />Anniversary Date: 03 / 11 / 85 <br /> 611ivED L1JiD ;itCU .'1,";:!r,; ! :YYI';G ; <br /> ~. <br />Please complete the following and return this form with your fees a nd <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: Annual Report and map to follow within 45 days. <br />Signature <br /> <br />3 ~~a,(b 5 <br />~,~~ <br />~,~ <br />