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,. <br />112 Attachment <br />Permittee Name: Ideal Basic Iaduatriea, Ino. <br />Operation iVame:. Goodwin Gypsum Quarry <br />Pertni t ~Vo a T7-346 <br />Anniversary Date: October 10, 1986 <br />Please complete the following and return this form with your fees anti <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 />X350.00 <br />R I Annual Report <br />I x I Map <br />Remarks: <br /> <br />®~. <br />~Q~', <br />Signature <br />(Rev. 5/84) <br />Doc. ~Vo_ 1305 <br />.. <br />