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i ! <br />110 Enclosure <br />Permittee Name: <br />Permit No: <br />Operation Name: <br />Anniversary Date: <br />Hi Valley Paving <br />M-82-033 <br />Bucky Clanch Pit <br />10/08/88 <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check space(s) below) <br />~/r ~, Oo Check or money order payable to Colorado Mined Land Reclamation <br />_ _ _Di vi si.on_ for annual _fees~ue-1 `~^ ~ "~ "~' <br />I~.f ,'~~ ' ~~ <br />~~ Annual Report ~~j 5 1988 <br />1rl~f~~[a L~Nf3 <br />rlec rl~-~~or+~ ©iv~sio~v <br />Remarks: ~l v ~.~ ~~,..~"' ~„-,.~ ~~__~ „ _~~ <br /> <br /> <br />~~~~~ <br />Signature <br />(Rev. 06/88) <br />0052f <br />