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<br />! i <br />~~ ~~ ~`'• ~~,;, "=~ ~ ~J Enclosure <br />Permittee Name: - Dt~ 1 •i, jQ87 <br />Permit No: Andersen Construction Company ,., ;-„ 4 ~`;,~4~ <br />Operation Name: M-77-053 '~''"•'"" <br />Anniversary Date: Lyle Smith Pit <br />12/23/87 <br />,- <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check space(s) below) <br />XX Check or money order payable to Colorado Mined Land Reclamation <br />Division for annual fees due <br />XX Annual Report <br />Remarks <br />~d~G` ~~t~~~ <br />Signature Todd A. Stockebrand <br />(Rev. 02!87) <br />5257E <br />