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<br /> <br />~ III IIIIIIIIIIIII III <br />s <br />110 and 111 Enclosure <br />Builders Aggr Co Inc <br />M-81-112- <br />Builders Aggr Pit <br />pera on ame. 09 / O1 / 86 ^„-~~r,~,-'~~~ 'r~~~-~ <br />Anniversary Date: I:~~. - =~ ~•'~~~-~,:_:j <br />OCT 2 ~ 9986 <br />Please complete the following and return this form with your fees and <br />reclamation data. , °~, ,_•a . ;;`~ r`,~'a:~',r:,: irl~,~ <br />.i: i is _ .,n,( :......... ... .. "J''"~.: <br />Permittee Name: <br />Permit No: <br />0 ti N <br />~`E~nc~l~osce~d are: (Check space(s) below) <br />~ _4n \`"~ Check or money order payable to Colorado Mined Land Reclamation <br />/~~ Division for annual fees due <br />/~ Annual Report <br />ure ~~~ <br />rb~~ 31 ~ <br />~~~~ <br />~~ <br />