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<br />Permittee Name: <br />Permit No: <br />Operation Name: <br />Anniversary Date <br /> <br />112 Enclosure <br /> <br />Albert Frei & Sons <br />M-81-202-SG <br />SILT PIT <br />11 /27/85 <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 />l// Annual Report <br />_ Map <br />Remarks: <br />Signature <br />