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<br /> <br />112 Attachment <br />Permittee Name: <br />Operation Name: <br />Industrial Resources, Inc. <br />Permit No: 83-194 <br />Anniversary Date: Januarv 31 <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check box(es)) <br />~~~ Check or money order payable to Colorado Mined Land <br />Reclamation Division for annual fees due ~/ sa ~ <br />t n c %s ~-cQ. c3 4 ~'ls. e~ 4 {+ ~ Z 7 S-- . <br />I_I Annual Report <br />I_I Map <br />Remarks: .SSwc ~ ~;'.t~.a-..« e~ /~ ,sw ~' ~,~oR-..-.. ~f <br />Signature /~„~ f,~ ~1 J/,.,L/~~ /~L= <br />(Rev. 5/84) <br />Doc. No. 1805 <br />c7e !/ <br />J. ~~ <br />i h .i. /~-.a-s ,j'. (., T~/~t sa ~.. ~+s,, .,c 7- c~ (P/ f - /~ <br /> <br /> <br />