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<br /> <br />111/112 Enclosure <br />RECEIVED <br />Permittee Name: Denver Brick Co O 8 1987 <br />Permit No: M-77-392 APR <br />Operation Name: Dawson State Lease MINED LAND <br />Anniversary Date: 03111 J87 RECLAMATION DIVISION <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check space(s) below) <br />X Check or money order payable to Colorado Mined Land Reclamation <br />Division for annual fees due <br />X Annual Report <br />X Map <br />Remarks: <br />Signature Consultant to the Denver B~{c Company <br />(Rev. 02/87) <br />5257E <br />