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<br /> <br />112 Enclosure <br />Permittee Name: Dorn Ready-Mix Corp <br />Permit No: M-74-092- <br />Operation Name: Barlow Pit <br />Anniversary Date: 09 / 16 / 86 <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check space(s) helowl <br />_~ Check or money order payable to Colorado Mined Land Reclamation <br />Division for annual fees due <br />Annual Report <br />Map <br />Remarks: Ste, ~_~ ~.. <br />5EP 1 ,_ _ .. <br />-, ,,. <br />•~d1P t' <br />~- If:n <br />r7~~ . <br />~; <br />~~~rZr n <br /> <br />gna <br />G((~(~ <br />~.~~~ <br />~, ~ e <br />_~ <br />